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Official Journal 
of the Canadian Nurses' Association 

A - Abstract E - Edironal 
Ja - January JI -July 
F - February Au - August 
Mr - March S - September 
Ap -April Oc - October 
M) -May N - NO\lember 
J. - June D - December 


Abonion coun
lling (Eastcrbrook. Rust) 28ja 
HeaJth haWC'mng.!t in the news. I3Ja 

ABOl"-\OlSSU", Enaam 
Nursing practice around the world. Ealitem Mediterranean. 4JAu 

CCHA gunk for lon
 renn care centers. 10D 
MontreaJ nuro;;e heads accTedllalion bod) (poru J8My 

The Canadian Institute of Child Health (Andrews) 21J1 
A child life program m action. 42N 
A comparatl\/c study of the self-acceptance of suicidal and oon- 
suicidal youths (Wesr",uod) A. 43Je 
From A to Z with adolescent sexuality (Schlesm
en 340c 
The Juvenile diabetic (Polowlch. EJlion) 245 

 STAT/"S OF \\O'\IF'I 
Health happenings in the news. BJa 

Corine Mar"'tt in Afghanlslan wilh MEDICO. 51My 

 praclice around the WOTld (Diereini) 4JAu 

See also Genalric
Beller qualified personnel would benefil aged. IOF 
A canng experience (Bawden) 24Ap 
Frankl) speakin
 !Dum.) 40Ap 
"Il's lime 10 g(1 home now" (Ford) 31Ap 
Living 10 eat (Grenby) 42Ap 
 .11< most 0/ .,.11< 
old<n y<ars" (Gr.nby) 39Ap 
N..ded: a ".", way of h.Jpin
 fMcAlary) 4
PraclicaJ concerns for nursing the elderly (Macdonald) 2
The R\'enlh a
e - carmg makes lhe differencC'. 2lAp 
Special issue. 23-S7 Ap 
Cenlral regi!!olr)' fOT commuruty nursing. 140c 

AlJocates S36.(K)() IV contmuing educalion. J JOe 
EdY'1I< Huffman. nam<d 1977 Nur.. of.1I< Year. 40Jl 
Helen Sabin named AARN honorary member. 911 
Hey. whal abOUllhe kids') 38N 

ALCOE, Shirlc) 
Chairman. CTRDA. Nurse's Section. 52Mr 

Did you know" " ". /4Oc 
 lhe alcoholic patienl (McGee) JOIC' 
Women in ambulance services. IOJe 

1977 INDE)( 



A'i'lL<\L MEFTI'iG 
Canadian delegates. BJe 

Nursmg fellowshlp
 offered. IOS 

The continuing learning ilctlvilles of graduales . . A. .sooc 

World Federalion for Mental Heallh (Zilm) IDOc 

Bk. rev.. S3N 

A'DREWS, Sh.ron 
The Canadian Institute of Child Heallh. 2111 

A'STE\ . Oli.. E. 
Pr..iden' of .he 'CN. 

Did you know . '4Oc 

The other side of the uniform (POrt) (Camiletti) 48Mr 

ReproduclJon and the test rube baby (Pakalnis. Makoroto) 34F 

ASH\\ORTH. Lyrm 
Lecturer. Queen's University. 100c 

Hey. what about the kids I - Commentary (Paso 44N 

<\SSOCIA T/O:>' OF CA:"ADlA:>' CO'\I'\11 :>'IH COLLEGES 
Health educators examine atternahves to current system. 8Ja 

AS.'iIlCL.\T10'i 0.- 'iE\\ BRI '1S\\IC" RFGßU:R..:D 
'1l RSI'G ASSIST -\:"TS 
NB RNAs set up separate organization. IOS 

PEl nurses promote changes in property laws. 18My 

 Order of of 

.\"""CL.\T!O' OF REGISU"RED" RSES lit 
'E\\TOl "DL.<\'D 
Brief to govi on nursing homes. 90 
Launches status study. IOle 

421<. 44J1, 54Au. 

Adolescence and learning disabilities. 44JJ 
The adolescent iliad. 44JJ 
Beha\o ia modification component in the treatment of obesity. 4411 
Birth control: lhe choices. 4411 
Breathmg exercises fOT the e)lpeclant mother. 42Je 
Canada !!oafetv council brochures. 421e 
Charge: Incompetence. a mock hearing of the Dj"'lpline 
Committee of the CNO. I SF 
Cnsis Intervention. 44JI 
The curb between us. -I.UI 
Ea., dnnk and be: wary. 44J/ 
Emergency [reatment of acute psychotic reactions due to 

ychoacti\'e drugs
Ethics afJd the law m practice. S4Au 
For tommow we shall diet. 44JI 
 due to loss of body image: don't cry for Da"'ld. I SF 

How 10 communicate. 421e 
Human dynamics of weight control. 4411 
Idea exchange: EducalJOn in the electronic a
e. 'Escott) I"iF 
Infant failure to thrive. 44JI 
The neurological n"alUalion of the maturity of newborn mf4:Jnls 
No tears (or RacheJ. 42Je 
One step ahead. 42Je 
Patientteachang. 42Je 
St John/Red Cross multi-media pro.JC'ct. I RMy 
Team up to conuol mfectlon. 4411 
Vasectomy. 4411 
Vocational rehablliLitlon In a community h()
pital -1411 
What's good 10 eat') 42Je 
Your moye, 42Je 

Thll18s that go bump in the mght (Worthinglon) 190c 

CNA e:ttecu!Jve dlJ'ectCY" rc:c
lve!!o RCN Honorary Fellov."hlP (pon) 
Dawn Mane Hanson. $J.lK.)O scholar!!ohlp rport) 48S 
Dorothy Percy receives FIoren...e NI
htmgaJe dward. HD 
Eleanor Grace Pa,;,k. recc,,,es a SI.IOO ..choJarsh.p .port) -1-)0.') 
Gayle: Blene. received the Lillian Campion Award from RNAO 
Heather Marlon Ogilvie. awarded $4.500 to begin dtxlnnd studleo, 
(port) 48S 
ICN 4:Jnnounces 1977 3M wlnner
. 16My 
Ingeburg Ursula Schamborzkl. receive... a $ I.QUO '-Cholar!'t:.p (portl 

Isabel Caroline MillOn. receives a SJ.(K)() scholarship (portl 4RS 
Jane Buchan. winner of thr White Si'\ler's Umform... Inc 
Scholarship Award of 51.000 and a CNF award 01 \2.000. 48S 
Jeannlece Beryl Lar!!oCn. awarded lhe Katherme E. MacLaggnn 
F",owship of $4.500. 48S 
Joan Irene Wcarin
. awarded a $3.000 !!ocholaro,hlP. 50S 
Judy Hill Memonal Scholar,hlp. 1977, 48N 
Kiyoko Matsuno. recel\'e
 a $3.000 scholar..hlp (port) 4t.<S 
Laune Dawn Reid. recel",e!!o a S
.OOO scholarship. .1RS 
Lifestyle award program announced. 16Mr 
Marilyn Darlene Bonenll. recei\les S3.000. 485 
NBARN Scholarship". 14D 
New Brunswick ASsoclêUion of Re
tered Nurse.... 48Ja 
Rae Mcintyre Chittick was honored at CNA s annual meermg 
(port) IOMy 
RNAO Fellow,hips, 48N 
Sheryl Ann Lapp. awarded the Helen McArthur Gmadlan Red 
Cro" F..lowshlp of 53.500. 48S 
\\tendy Lynn MçKni
hl. receive
 S2 000 (port) -185 


BAGOLE, B.rbara 
Repre\emative. P.E.I.. CCCN. S2Mr 
BAJ"'''. Irmøje.n 
Bk r<y"" 46JI 
B.<\LI.. Ger.ldine 
NBARN schoJar>h.p. 
BARBER. J.du. 
The tip of the IceL 

B.\HR. Laura \\ 
Assistant exe 
MedICal Ce. 

B\k'U'Ci 10'. I'atr-ida 
1 h... ..dh.dfC urnt (JXlrt' wr 

. ))iant' 
Th... lull,. 
)t Ihe hCdd nur!!.c m prlmdfY nur!!.inf!. (POri) (Guod. Lampe

H \ Il"HH OR. Gru,e 
ll1 ur
.hno1lur COnllnulnf!. Edu...o1t10n O",I..lon ul Conunuml)' 
IIt-.illh" hcull} 01 LJ 01 T IpllrtJ 48Ja 

Ii \1 '](;-\Nl. :\liL
Dean S...houl 01 Nur!!.mg. QUl."t:n, LJm\oer..lty" ...OJI 

B \ \\ In,. \lHr-
A ...dnn
 expencnce. 24Ap 
Chmldl word!!.can.h. 25Mr. 4:!M). ltsJe. _\9JI. 27Au. 17D 

A ...onlmuurn of lare I Emond) S2Ap 

H"'AI CII-\ 'II'S. "randm. 
mali\o(:. Quebec. CCCN. 52Mr 

ß.....u 1'(,. Tnni 
Repre..enlo1ll"e" So1..ko1lche"an. CCC
. S:!Mr 

H..-G". 'tunique 
Replace, Lalonde m cCiÞmet !ohufne. y

Beha\olorallherap) (MacDunaldJ :!611 

ur"'ll'f: the alutely ps}chouc patlem (Berew"..k)) 23F 

HERFJ'O\\S" \. Jun.' B. 
Care H. lu..wdlah!)m (de Omf!.il!!.J 161e 
Nur,lOf!. Ihe acutely p!!.)'Lholic pallen.. 21F 

H..N.(;FN.()'. (;eoq
ApPulnled ho1l'-lm ollilcr of NBARN. ...9N 

8FN(;'t-\'. Nt'ht'cca 
hr..t "1...c-pre
ldcnt 01 the ICN. 50S 

Kt R' \N.J). (.olumbil'nm' 
NBARN '-l.huldf'hip. 4XJOj 
B I::.
EI . I or-ine 
 hold, 61'I.mnual meeling. 6S 
Roundup of critllall'
ue!)_ CNA meellßg 1977. tsJe 

HFSSl.IlF. \/ichc' C. 
Idea eXLho1nf!.e: A hdz..J.rd of mtra\enou!!. theriipy. 14Je 

HIHK\. I iIIian 
SI lnhn Ambul.snL.e lß\'e,lllure. 14D 

HnTH. (;u,l. 
H....l,.cIH.d the Lllhdn Campion A"dfd from RNAO" 4XN 

Hm I, h). 
I mplnyment Rel011iun.. PU Nur
e.. Pmvmllo1l ColleL1.i\o'e 
 Cummiuee. S2Mr 

HI Oü[) rIlA'
l\. ne" blood
lu.!)Ion Iherapy: .sulotranstu!)ion IH.slwdfd) 
HI (11"1. J.ff A. 

el,.n.tary Pnmary Cdfe-OutreOjlh Project Comnllu
e. U 01 T (pori) 

HOII'-HRO\\ 'I'. Regina 
Appolßted to the faculty. M..: M.t..t
r. 170c 
H.s.. rLxel\ed 01 t\:HRDP 
Lh(ll.u dward. 17Ul 

UOIS\ FN. I. Cl'LiI(' 
VI...c-lhalrman. CCCN. 52Mr 

BO'II L\. Irma Sandmal 
NW..lßg art und the "orld. 
outh and Cemral Ameflla. 47Au 

HOO" RF"\ n \\
The aknholic. 55Mr 
Andu,on. Paul D." ChnlCdl an.slOmy and physlolo
y lor alhed 
heo1lth ",c.enLe... 
Arnu". Edfle L Imrodulllt.Jß 10 ph},w1ol!u.:al .snd palholo
L.heml'lotr)' 4611 
B.tdglcy" Robm F Report uf the 1,.0mtnlUec on Ihe opercll1on ofthe 
dbortion law. 45Je 
ti.1Jber. 101nel M " Adull clnd child "'dfC'. 460 
Italhryn E . Te.schmg lhddren with cJe\-dopmental 
L.are apprualh. 4611 
ary andlum}. 54My 
enwlly retarded and sociclY. ...6D 
Unil}' heahh and nur!)lßg prat..lILe 

f the lacl.tlly burned and 

ChllcJlxarlng (SalernLl) 

". ...6JC' 
:!Iplto1l and Ihe 

Clark. Ann L . Childbearmg. a per!)\le CAllon!)o) 47JI 
Cra:lg. Grah J Hurnil.n developrnenl. 54N 
DcCOj!)tro. Ferndndo. The pediOjtnc nur,e praL.tioner. guidelme!!. for 
pritlilce I el al) 53N 
DeGowm. Elmer. Bcd..ide dlagno!)lIc exammation (DeGowin) 4tsJl Helen M.. Nur!)lng !!.erVlle .sdmIßl!)trallon: m.snaginf!. the 
. 54M) 
Dunu\lo1n. Mo1ureen Iver!!.. Cdnçer care nur!)Jßg (pierce) 55S 
y. Rli;hl and reé:l!)on. ethICs m Ih
ory Cind prOjdlce. 
FI!)Lher" lo..el E.. Total parenteral nutnllon. 47J1 
Fordyce. Wilbul. EiehavlOrdl method, lor chromc pam and IlIne!),. 
International Nur
lßg. Index 1976 Cumulalion. S5My 
laL.ob)'. Florenle. Nur
lßg care of the patlenl with burns. 5SMr 
Leahy. Kathleen M." Commumty health nursmg. by . et al 
Lcminger. MOjdelin
. Barriers and facilitators to quality health 
care. SOJa 
Lelßinger. Madeleine. cd.. Health care dimensions: health care 
 (BuLk) 54M) 
Mclnne,. M.rry Ehubeth. E!)..ential!) of commuDicable diseases. 
MarTIner. Ann. The nur!!.mg prOle!)!!. A !)clentific approach to 
nur!)lßg care. 46JI 
!vIllls. Gre:=tchen C. DI!)çu",,,,mg dealh; a 
Ulde to death educatIOn 
(et al) 55Mr 
. Donald A". Are you dri\ Ing your children to drmk? Coping 
""ith teenage alcohol and drug abuse (Burger) S40c 
Pas!oman. Jerome. The EKG - Basic technique!) tor Ißlerpretation 
(Drummond) SSS 
Pillitteri. Adele. Nur!)in
 care of the growJßg family; B maternal- 
newborn text. S3N 
Quinn. Joan. Commumt)' health and nur,ing praL.lice. (Ben!)on) 
SdflllU\-Ruth!)duld. Con'tantlna. Love. sex and sex roles. S3N 
Sagcbeer. lo\ephme Evan!). Malernal health nurMng review. 50F 
Schultz. Rr"-..k"ell. Management of ho!!.pltals (Johnson),)5N 

hweer. J
an E.. Creatl\o'e tCdchml! m climcal nursmg (Gebbie) 
Skydell. Barbara. Dlagno!!.tlc procedures_ A reference for health 
practilioner!) and a 
uide for patient counselin
. 50F 
Stone. SCindra. ed_. Manaf!.ernent for nurses: a multidl!)ciplinary 
approach ( _ et al) 550c 
StOlT'. Ali",on. Genatrlc nursJßg. 55N 

501d. 50F. 55Mr. 5-1My. -I5Je.-l6JI. 5-1Au. 55S. 510e. 5'N.45D 
BOTTFRILL. 'tar-il)n Darlene 
Re",cl"e.. $'1.000 !)chuldf..hlp. 48

BO\\ 1::."\. uona \ldrgant 
l\-1.tJ,t d'\lmgui,hed graduCite m nur,mg. LJ 01 Sd!)
80\ I .... Barbara 
Dco1r Me. RdJ.sbcllly (Murthy) 7D 
BRAIJI E\, "uthr)n rcprc
enlcltl\e. Alberta. CCCN. S2MI 
ON. \'..-AL. Suzanne 
Dlfellor of the Family Planning Divi"iion. Health and Welfare. 
Fan1lly planmng. move!!. inlo high gear. nurse!) active in federal 
ram. 16My 
IIREA"E\ . Joan 
t CCCN. 5:!Mr 

BRIA:>' r. :>'ora J" 
hankl)' !)peakmg. What every rea!)onable and prudent nurse shoold 
kno". l31e 

HRIlISH COIL MHI\ GOn"R'MEr-.l ."MI'I n\n. 
RH \1I0r-.
 HI RF""\l 
B.C. nur,e, oICcept t"o-year contraLto 81e 

BN.()()I\.S. "-a}e 
A'31,lanl prole"or" Queen"!) UnlVer'ily. 160c 

HRO\\'1. Mu) 
SeL.ondary !)chuol nur!)mg. a changmi; tocU!). 420c 
BN.O\\.:\. PatriciH L}nne 
Cour!)C ledder. Um\o'erMly of Alberta. 160(" 

BURA'. Jun. 
White Si
ler"!) Umform!!. Inl..". Scholarship Award of $1,000 and 
CNF award 01 S:! .000. 4tsS 

III RG.:SS, I'h)lIis 
Retued a
 dlre:=l,.lor of nur!)mg at Pnnu:!)!) M.t.rf!.dfel Ho!!.pltal. 
Toronlo. SIMy 

Bl RI\.F. Juliette 
PrOlel,.lIve l!)olo1llUn umt. Montreal General Ho
pll<il. 26Au 

ßl RI\.E. MHrun .\-t" 
Pre"ldem of th
 Cdnadidn AddlLtion Foondation ICAF) 49N 


HIII'IFI'" I), ""'a 
A""ij!)lanl proft",
or Queen',. LJru\lenlly Jt:JOc 

Burn update (LeFort) 16Au 
COpJßg with pam: !)tralegles of severely burned children (Savedra) 
Nutrition and the burn patient (Fortier) 30Au 

Bl R\\FLI_, [)uruthy 
Psychodrama and the depressed elderly. 54Ap 
Bill EN. Oarbara nervo!JoOj. a nursmg. a:pproaLh (Duke. Stovel) 22Je 


55Ja. 8F. 54Mr. 50My. 391<. 41J1. 4Au. 51S. 80e. IlN. 15D 
CAMF"LETTI. \olunda 
The: other side of the uniform; living with Adult Still's Dlseasc 
(pori) 48Mr 
CAMFRON, MHrgaret 
St. lohn AmbulOjnce Investiture. 14D 

OI.o, luna 
World Federation for Mental Health (Zilm) 100c 

Cystic fibrosis-camp Couchlchmg . fooT summers (SCOII) 141e 

CANADlA:>. A[)DlCTlO:>. H)LN[)AlIOr-. 
Marvm M Burke. president. 49N 

t affiliate member of CNA. 13My 

Kathy L..auzon appomted executive-secretary. 121e 

Meelmf!.. tsD 
Member!. 01 the Ex.ecutlve Commlnee. S:!Mr 

Ulde of long-tenn center!!. of care. 10D 
Montreal nur
 heads accreditation body (port) ItsMy 

Re!soCarch award to Jo-Ann Tippett Fox. 170(" 

 HF:ART HII N[)A nor-. 
Cirdlovd!)cular nur!!.e!) meetin
. 8D 

HemophillaL"s !)tudied. 130c 

CAr-.ADlA:-o. I
A personal re!)pon!)ibillty (Andrews) 21J1 

Robert Gourdeau. president. 50S 

Appoints dlreL.tor of Ltbor Relations Servu:e!). 18M)' 
e' 197H. IOD 
MARN hO!)b first natiunal ,crnmar on ,tandards 01 nurMng 
practice. 6N 
Constance A. Swmton. on loan from CIDA (porI) 41J1 
Fmancial !)tatements and auditors' report. S6Ap 
Glenna Rowsell director of Labor Relallons Services (port) 4tsf 
H Rose Imai. director of professional ser\'ices (port) 50S 
Hallie Sloan. nursing coordlDator (port) 40JI 
Heallh promolion program: phase two. IIJI 
Mary E. (Sally) Robertson. summer residency (port) 41J1 
Nicole Fom.ame. DlfectorofPublit. RelationsServices(port) S2M 
Per!.pectlve (Gilchnst) E. 3My 
Rep attends world food symposium. 140c 
Re!)earch !)tudy reveals few key cbange", in nursing employmen 
education pattern!) smce 1966, 12Mr 
Respiratory nurses seek CNA affihatlOn. IIOc 

Head table guests. II My 
New!.. IOMy 
Notice of . ,I2Ja 
Program. 10D 
Resolution",. 12My 
Roundup of critJcallssues. 8Je 

:>;A[)JA:>' " RSES ASSOCLA no:>.. BOAR[) O. 
CNA !!olIpporiS special inter-eM grou
. 130c 
Highlighh from CNA Director!)' meeting. 13M)' 
Hold work ses
ion to consider nur
lßg directions. I SMr 
Meetmg October 20-21, 100 

June 25
28 In Toronto. 14Au 

Report 10 membershIp. II My 
Nurses try out fitness model. 7N 

Appomb director. 18My 
s.. Library updal. 
Evaluation of OHA Nursin8 Competcncy Mode) ProJcct. 100 
Ponrai.. 12Ap 

Comprchensl'llc exam scheduled for 1980. IOD 
Statement of Income. .59Ap 

Nurse heads N. W .T. PubJic health association. 121. 

Arlene Draffin Jones. chauperson. 48N 
Shirl.y Alcoc:. Chairman, S2Mr 
ASSOCIA no,," 
15 sending two reprcsentall'o'cs to lhe 19771CN Congress.n Tokyo. 
CVNSA delegates meet in Calgary 10 examine nursing and the law 
(Parisb) 16Mr 

Copmg with cancCr: a symposium for c
cryone. 1Jc 
Health happenmgs In the news. 13Ja 
Laryngectomee leaflet (Vandewater) 48Au 
MlfTonng (Klkucbl) 31Mr 
Report of the Task Force on Cer
ical Cancer Screening 
Programm.s (tl>< Walton R<port) 12Ap 
Corn1e Mar1att in Afghanistan with MEDICO. 51 My 
Palricia A. Phillip,. proj<Ct di'<CIO< (port) S2Mr 
Sharon Dawe wltb CARE/MEDICO 10 Honduras (port) 12J. 

CAR'\IACK, Marilyn L. 
Assisrant exccutive directa of RNABC (port) I60c 

World F
ation fo< M.ntal Health IZilm) wOe 

CARTER. Rosalyn 
"'orld Federation for Mental Heahh (Zilm) 100c 

CARTY. Elain. 
Alternal1ve binh centers. (Rice) '\ I N 

CASE. Ouri. 
ARNN launch.. status study. ]OJ. 
Listening doc:s I><lp (Winberg. Hobson) 405 

CHARTRA:-òD. Paulin. 
Family plaMing moves into high gear. 16My 
NurSC' consulrant for the Fanuly PlaMlng Dj\'is.on. Health and 
W.lfar.. 16My 
Singing ...igning smiling (Samanski) 28F 

The Canadian InstllUte of Child Health: A personal responsibility 
(Andr<:w,) 21J1 
A child life program an action. 42N 
CHITTICK. R.. Mclnlyn 
Honored at CNA's aMual meeting (port) IOMy 

CHOQl"ET. Rila 
St John Ambulance Investiture. 14D 

CHl 'G, Hsin Hsin 
Nursing around the wald. WeSlern Pacific. 45Au 

CLARKE. Healber F. 
Challenging the stlrus quo. 4())a 

VGH reorgamzes nursing departmcnt. 8N 

Executive Director. SRNA resigned to go to Dept. of Heall!1 (port) 

COFFI'II. Tri.tam T. 
St John Ambulance Investiture. '4D 

Instructor. Grant MacEwan Community College (pon) S I M) 

See also Labor relations 
B C. nurllies accepl two-year contract. 8Ie 
H.C nurses jOin pubJic employ<<s. UJI 
P<rsp<<ti.. (, E. 3My 
Perspective (Hanna) E. 40c 
Separatt collecti\/e bargaining body for Alberta. 13JI 

Glennyce Sinclair appointed Director of the Diploma Nursing 
Program. S I My 
Helen M. Evans. appOInted president. J70c 

(:OMER. Mary 
R<p,...ntati..s - to II>< 1977 ICN Congr.... SIMy 
Adelc Hc:rwirz appointed execun"e director. 51 My 

Racl><l Palm.,. PRs"kn.. S2Mr 

H..ltb bapp<ning'. 12F 
Spec..l isolation unit. 100c 

Did you know" ". 16M, 
Laryngectomee Leaflet (Vandewater) 48Au 
List.nmg doc:, b<lp (Wmba-g. Hobson) 40S 
Singing signing smiling (Samanskl) 28F 

An analysis of the application fa the Io:oncepl of family-centered 
care in pubJic heahh nursing \lisits (Cunningham) A. 45J1 
A canng experience (Bawden) 24Ap 
Central registry for community nursing. 140c 
Community resources for the elderly: 2 programs. 
(<r) 47Ap 
Day therapy centre the role of the primary care nurse (Morlok) 
Frankly "",&kmg. go.mutt.nt for ..born' (Gosselin) 19My 
Id.. ..cbang. (L<Blanc. Schullz) 29My 
Listening does help (Wmberg. Hobson) 40S 
McGill Research Unit to srudy commuruty health nursing. 9Ja 
Retired nurses aid elderly an Alberta. 9J1 

Family life delegates examine health care. JOle 

CNA rq> at..nds world food symposium, 140e 
CUNSA delegates meet in Calgary toeumine nursing and the law 
(Parisb) 16Mr 
MARN hosts first national seminar on standards of nursing prac- 
MARN standards meetin
. 90 
RNAO's nursing process project underway. 8N MeC'tmg of the Auoclation of CanadIan Communuy 
CoIlrres. 8J3 
Cardlo\'8.\cular nurses meetmg - Toronto Hean Foundation. 80 
A conference for SUperviSOrs. 6S 
Coping with cancer: a symposium for e
onc. 7Je 
Emergency nurses hold :sixth annual conferencc. 6N 
Forum for public health nurses. 2nd. sponsored by RNAO. 1218 
International Oûldblffh Education Association. 12Ja 
N S. occupational health nurses hold seminar. 1211 
Orthopedic nUf"òCS hold education day. I 2Ap 
Pediatric audiology workshop aids nurses. 12Au 
Thing, tbat go bump in tl>< night (Worthinglon) 190c 
Thirtieth World Health A.ssembly in Gene\'a. SWlfzerland. 7JI 
World Federation for Mental Health draws 2100 concerned 
prof...iooals (Zilm) 100c 

Perspective (Hanna) E. IN 

See Intensj\/c care facdlfles 

CORMIER. Simon< 
NBARN bolds 61st aMual m..ling. 6S 

Health happerungs in the news. 13J1 


CROSBY. EJizah,'b. F" 
O'llldhood diabetes. the emotIOnal adjustment of parents and child. 
IG"nn) 39Ja 
CROZJER. Donna Elain. 
LeclUrer. University of Alberta. l60c 

Health e
change program recel\/es official approval. 16My 

Cl'llNI'liGHAM, Rosella 
An analysIs of the applIcation of the concept of family-centered 
care in public heahh nursang VISitS. A. 45JI 

CI"RTlS, o.arlotl' 
Bk" ,..". S4My 

Cyslic fibrosIs-camp Couchlching (SCOlt) 14Je 


DA \/OSO.... Ju... M. 
Bk" R'". SSS 

DAVIES. Lorr..n. 
Disaster plannang. 46My 
DA WE. Sharon 
Witb CARE/MEDICO in Honduras (port) 12J. 
DAWSON, FJiza""'h 
Instructor. Grant MacEwan Community College (port) SIMy 

DAY. A. 
Bk" R'". 48J1 

Community resources for the elderly (SctvraM'hnerder) 47Ap 

The role oi the pnmary care nurse (Morlok) SOAp 

AnatOl\1Y of a ð<a'b (Estabrooks) 300c 
Connection (Inns) 4JMy 
b bapperungs. 12F 
0". g.ntl. man (Walsb) (port) S6Ap 
Rigbllo di.. 4SJI 

Care VS. cuslodia]ism (Berezowsky) 36Je Mr" Rajahally, 6D 

MARN representatives meet with cabinet. 12Mr 
NBARN holds 6Jst annual mðtlJng. 65 
Accountability (Poulin) 30F 
Otallenging the stalUs quo. 40Ja 
Family life delegates exanune health care. IOle 
Heahh exchange program receives official approval. l6\.h 
H.y, wbat about II>< kids' (Alcock) 38N 
Hospitalization tLa;og) 3SN 
New horizon for nurslflg. Part 2. Nursmg practice around the 
world. 40Au 
Ontario nurses document declinmg 51andards of cart. 14Ap 
Persp<<b" (Hanna) E. 3Au 
DESAI. Kanchan 
We took physical fitness to the county fau (by . et al) 25Je 

DE SIL\"A. Hilda 
Nursing around the world. Southeast ASia. 46Au 

Olildbood d,abd.. /Crosby) 20S 
The ju\/erule diahetlc <Polowlth. Elliott) 24S 
Tn-Hosplral diabetes education centre (Laugh
. SIemer) 14S 

A school screening program that works (GUIT) 24D 

Protective isolation unit. Montreal Genera] Hospital. 26Au 

DI E R. Kalhl..n A. 
A.ssocute dean. UmvO'"Slty of Alberti. J. . 

See Emer

Early Identification of de" 
to nine months of c 

DOIRON. Cheryl 
NBARN scbolars 

DOlCET. GI.nda 
Idea excha ell.. 

Drug ad w8(chdog assumes re
ponslbiht}. IOF 
Health happemngs in the ne
s. 1311 
Prog:rammcd learmng: cardiac depre:!o
i1nb (Wdfkenun) 'OM)' 

Dl FFU-. John 
Fran"l} speakmg: Aging: the myth and the reahty. 40Ap 
Dl k.F, Mar) Jane 
Anorexia ner\lo!;a- a nursing. approach I Butler. Stove!) 221c 

Dl \LAS. Louis< 
po..toperative cardiac surgical pi1.Uenb' opmlnn.-. i1.boul !!.b'"ul.tured 
preoperative tcaching by the nurse. A. .t.4Je 

"L. Nicole M. 
SI John Ambulance Inve
tllure. 14D 

Wgh CARE/MEDICO in lodonesia (porI) 48Ja 


Abortion counselling: a new rule for nur!!.c!i. lporl) fRusn 21Hd 

Nursmg practice around the world (Aboo- Y OU.M'IoCf) 43Au 

The taxman cometh (Grenby) 36J.a 

Alberta nurse educators form new aSSociatIOn. 8Je 
CNA research slUdy reveals few key changes m nursing 
employment. education panems since 1966. 12Mr 
Education In health care in an Intercultural maternity 'iOenlce 
. S2N 
Frankly 'peakIl1g. Dear Mr RaJctball) fPrev.'\e et aD 6D 
Health educators examine alkrnatives to current sy'-'Iem. 81a 
Idea exchange (EducatIOn In the elecb"omc age) (E
lnternal evaluatIOn of an expenmental dacum curnculum m a 
diploma school of nur'\lng (Hdlibunon) A. "'00c 
MARN representatives meet with cabm':l. 12Mr 
Mrs Band m< (Sproul) 46F 
NBARN presents brief to education commlltee. 1Je 
The nurse continuum per'iopectlve (McGee) 24Ja 
Programmed learning cardiac depre

 I Warkentm) JOMy 
Why nursing') (l...c:ckle. LoITee) JOD 

UNB announces changes In nur!<>ing prog:ram. 121- 
Members back MARN al .-.peclal meehng. 7N 

FDl"CATlO". CO:'ooTl'll '''G 
AARN allocates S'6.CXJO to contInuIng edm.ahon. IIOc 
The continuing learmng acti\oltle
 of graduate.-. of t\HJ diploma 
nursing programs In Ontario (Anderson) A. 5UOi. 
Did you knQw "" 16Mr 
Frankly speaking: so you want to make a comeback (\1c..Keekan) 
Frankly speaking: what every reasonable and prudent nur
e should 
know (Briant) Ule 
Orthopedic nurses hold education day. IZAp 
The tip of the Iceberg (Bartter) 'lJa 
The contmuIng learnmg aCII\oltles of E!radmlles ot two diploma 
nursmg prog:rams In Ontario f Ander
on) A. SOCk 
Inlernal evaluation of an expenmental dacum curnc..ulum In a 
diploma school of fHahbunon) A. 500c 
Orientation and in,ervice programs for teachero. In C.madmn two- 
year schools of nuning (Field) 44D 
Pctformance u.pectations of new grads. (2J1 
A program thai dares to he different (port) (Skelton. 36Mr 

MARN representatlve
 meet with cabInet. 12Mr 
l' of Victoria focu
s on elderly 110e 
M SC". (Applied) offered to non-nurse.-.. I3Ja 

ELFFRT. Helen 
Se1e\..ted aspects of the chldbearmg expenenc.:e . (l...c:onard) A 

MFRS. Barbara 
".cror. SRNA lpon) MAp 
EI Llt.JT. ..orol. 


Ell lOTI. Ruth 

011&. ontH\1 
 I Polowlch) 145 

lLLI'_ Pall 


. b. n
 (LeFort) 16Au 

DI'ioaster planmng (Davies) 46My 
Emergency nurses hold sixth annual conference. 6N 
MARN supports Alert. ISMr 
Nurse to direct Information Cenrre at Hospital for Sick Children. 
NUb"ition and lhe burn patient (Fortier) 30Au 
Ready for any emergency 200-bed hü.!.Pltal-in-a-box (l...c:Fort) 
tudy of cuntinuity of nursmg care frum the ho
pital emergency 
room 1010 the home (Perkin) A. 43Je 
 that go bump 10 the mghl (Worthington) 190c 

Hold sixth annual conference. 6N 

A Canadian grad goes 10 the States (Zin) 460c 
CNR holds policy session. 9Au 
EMO'D. Suzanne 
Bayclest Genatric Centre: a contl'nuurn of care. S2Ap 

Belter working condition!. fur nur
50. 6S 

F"{;USH. John 
Appoint.d to III< faculty. McMasl.... 170e 
HelpIng young ostomy patienb help themsclve!t (Tisdale) 3011 

Did you know? 1311 
Health happenmgs in the news. 131a 
Highlighls from CNA Directors' meeting. 13My 
World Envlfonment Day - lune S. 1977 (Hanna) E. 3Je 
Ethics and the: law in practice. 54Au 
Idea exchange (Education in the electronic age) ISF 

E"TABROO,,"S. Carol. 
Anõ:ltomy of a death. JOOc 
NBARN .cholar.;hlp. 48Ja 
Accountability: a professional imperative (Poulip) 30F 
Code of elhics implemenled in Quebec. 13Ja 
Elhlcs and the law m practice (Escott) 54Au 

t'.ur"omg around 'he world (StaHknechn 43Au 

Mrs. B. and me (Sproul) 46F 
S. Helen M. 
Appointed presJdent of the Council of the College of Nurses of 
Ontario. 170e 

E\ ERARD. Jean 
Nurses tryout fitness model. 7N 

Glaucoma: awareness pJCvenls blindness (French) 200c 


Orientation and mservice programs for teachers m Canadian two- 
chools of nursmg and sources of sallsfacuon and dissatis- 
faction a.-. perceived by the
e teachers (Field) A. -I4D 

Cñangmg patterns of marnage and family livID@:. 140c 
Family life delegates examine he.dlh care. IOJe 
The fathers side: a different perspeclive on child-birth (l...c:onard) 
Helping a family and their premature baby grow rogether( Murphy) 
es need nurses too (Silva) 38 Ð 

Family planning moves inlü high gear. nurses active in federal 
program. 16My 
Heallh happemngs in the news. 131a 
Reproduction and the test lUbe baby: a mUled explo
(Pakalms. Makormo) 34F 

FA\\KFS, Barbara 
Rcn fello..... named acling ICN head. 18My 

See A wards 
flFI D. Carol 
Onentation and mscrvlce progralT15 for teachers Iß Canitdlan two- 
year \chools of nUNmg. A. 44D 

t"I'CH, Elizabeth 
Sexualily and the disabled. 191a 

flNLA \ . Lynda 
NBARN scholarshIp. 14D 


Burn updale: what you need to know about burns (l...c:Foro 16A 

How do you feel about . working nights? 34S 
See also Ford. Lynda 

LAHERTY. M. Josephine 
First repon as PNO '0 CNA Board. IOD 
Resigned as dean. Faculty of Nursmg. UWO (port) S I My 
UWO Dean of Nursing addresses Seneca College Education D. 

FLA'IIAGA.'1, Eileen 
Receives LLD from McGill. 14D 

FLETCHER, Geraldine 
We took physical fitness 10 the county fau (Desai. . el al) 25 

"1I's time to gn home now" another look at nursing hon 
(Ford) 31Ap 
Director of Public RelalJons Services. CNA (port) 52MI 

FORD, Lynda 
Idea exchange (The difference between night 8nd day) 46J8 
"II's time 10 go home now. ., another look at nursmg horn 
A question of balance; the effects of chromc renal failure and 10 
tenn dialysIs. 19Mr 
See also FitzpBb"ick. Lynda 
FORTI ER. Rosemarie Repa 
NUb"ltlon and the burn patient. 30Au 

FOL RMER. Fernando 
NBARN scholar.;hip. 14D 
FOX. Jo-Ann Tippell 
Appom"d to tll< faculty. McMos..... 170e 
hlp. Medical Research Council. 170c 

FRA7ER. Diane 
NBARN scholar.;hlp. 14D 
Representative. Nova Scotia. CCCN. S2Mr 
FRESCH, Eileen 
Glaucoma: awareness prevems blindness. 20De 

FRE"lOl, Patricia Harcourt 
A gift of tomorrow. 2011 

FlLKERTH. Margaret A. 
St John Ambulance InveslitW'e. 14D 

Ft;:-iGER, Gad 
To direct Information Centre at Hospital for Sick OUldren. I 

Fl RNELL. Margery 
Has joined Alberta Social Services and Community Heallh. DI 
sion of Local Health Services. 160c 


Bk" rev". 4SJ. 

GAt:LTON. Lucili. 
Secretary of NBARN. 95 

ReprodJctlon and the test tube baby: a muted explosIOn 
(Pakalms. Malr.orolO) 34F 
See also Aging 
Baycrest Geriarrlc Cenrrc. a continuum of care (Emond) S2AI 
B.havioral thc:rapy (MacDonald) 26)1 
Better qualified personnel would benefit aged. IOF 
Commumty resources for the elderly: 2 programs(Schattschneid 
God's love and a jar of honey (Moynihan) 285 
Perspective (KelT) E. 4Ap 
Practical concerns for nursmg the elderly in an instÎtutional sett 
(Macdonald) 2SAp 
Psychod-ama and the depressed elderly (Burwell) 54Ap 
A quiet day. (McKenna) 20Je 
Retired nurses aid elder1y In Alberta. 911 
Secrets of long life. 140c 
U. of Victoria focuses on elderly. 110e 
PerspectJve. 3My 
GIRARD, Alic. 
SI. lohn Ambulance Investiture. 14D 

GIROl ARD, :'ooicol. 
NBARN scholarship. 48Ja 

GLASS. Hel.n 
Roundup of cnhcalls!!oues. CNA annual meeting 1CJ7? SIc 

GLASS. Mary Ann 
NBARN scholar.;hip. 14D 

Glaucoma: awareness prevents blindness (French) 200c 

ariB Rubilie 
Crossword puulc. 39J8 
GOOD. \hisn 
The ro1c of the head nUr!
e in pnmary nur!!omg (POrt) (Banels. 
Lampe) 26Mr 
FrankJy speaking: government for whom'? 19My 
Roundup of critical issues. CNA annual meeting 1977. SIc 

GOl'RDEAl'. Rob..t 
Pre!t.ldcnt of the Canadian Medical Association. 50S 

GOl:THREAl". Suzanne M. 
Of R.M. Brown Consultants 'port) 160c 
GO"'. O1ri!'rltina 
Bk. rcv.. SOF 

A. Judith Prowse. appomtcd chamnan of the Health SCiences 
o.partment (port) 48N 
Appomtm.nts. 51 M) 
B. June Colberg. InstruclOr. E.xtended Care Nursmg Program. 
51 My 
Ehzabeth Dawson. Instructor of Ihe Occupational Nursing 
Certificate Program (port, SIMy 
larlene A. 
Appointed Director of Nursang Service. Vlctona General Hm.pltal. 
Hi:l.lifax, Nova Scotia. 48J8 

GRA \ ELLE. Henriell' 
Appointed CNA translator. 48Ja 
GRA \ DO:'oo, Jane 
Outpost nursing in northern Newfoundland (Hendry) 34Au 

GREEr.;, Esth.. 
Appointed to the faculty. McMaster. 170e 

Livmg to eat: nUb'ltion for sernor citizens. 42Ap 
Making the most of 'the golden years". 39Ap 
The: com'lh (port) 36Ja 
GREI'<t"ELL. \\ilfred T. 
Outpost nursing in northern Newfoundland (Graydon. Hendry) 

Gl RR. F. 
A sChool screenmg program that works;. 24Ð 

Idea exchange: well women and health awareness c"ruc (Doucet) 


HAGAR, Lorraine 
The nursing process. a tool to individualized care. 380c 

HALlBl"RTOr.;, Jane Cia.. 
Internal evaluation of an expenmental dacum cunlculum m a 
diploma school of nursmg. A. S<XJc: 
HALL, Laura 
Murplly.s glu.. 42D 
HAL \\ ARD. Margaret An". 
A new look at blood transfusion therapy: autotransfusion 38My 

Congerntal dislocated hip (Nichol) 14J1 
Sexuality and the disabled (FlOch) 19Ja 

HANNA, M. Anne 
Perspective. E. 2Ja. 4F. 4Mr. 211. 3Au. 3S. 4Oc. 3N 
World Envlfonmem Day - June 5. 1977. E, 3Je 
.cu.J HANSOf'.. Dawn Marie 
SJ.OOO scholarship (port) 48S 
St John Ambulance InveslUure. 14D 

HAYES. Marjorie 
Sr. John/Red Cross multi-media project. 18My 
tiA YNES. Jo Anne E. 
Appointed to the faculty. McMaster. 170e 

Bêgin rq>laces Lalonde in cabinet shuffle. 9N 
Federal transfer health services bo Yukon. 9D 
M Josephme Flaheny'
 first report to CNA Board 10D 

M. Josephine Flaherty Prmcipal Nursing Officer (port) 51M)' 
NorahO'Leary Nursing Consultant. Health Programs Branch. 48Ja 
Norah O'Leary. Health Standard... Directorate of the Health 
Programs Branch tJxm} 50S 
NUb'1110n Canada Dental Repon. IJOe 

Day therapy centre. the role of t"- primary care nurse (Morlok) 
H.alth happenings. 140e 
Idea exchange: well woman and health awareness chmc (Doucet) 
The nurse's role In health asse
ment and promotion. 40Mr 
Nurses to complete new health forms. 8Ja 
Secondary school nursmg. a changmg focus (Brown) 420e 

MARN supports AI.rt. 15Mr 
Postoperallve cardiac surgical patients' opinions about structured 
preoperative teaching by the nurse (Dumas) A. 44Je 

The effects of conranUlly m nurse-paraent assl
nment amon
setected group of preoperatJ\.e aortocoronary bypass pallents 
(Rosa) A. 45J1 
Programmed learning: cardiac depressants (Warkentin) 30My 

Hemophiliacs studied. 130e 

HE'DERSO'. Ian ".D. 
Drug ad watchdog assumes responsibility (poru IOF 

HE:'ooDRY, Judith M. 
Outpost nursing in northern Newfoundland (Graydon) 34Au 
Peter: an infant "ith a mydomenmgoceJe (port) 15Ja 

HER\\ITZ, Ad.le 
Appointed execullve director of the Commission on Graduates of 
Foreign Nursing Schools. SIMy 
HE\\ ITT, Michael 
St. John Ambulance In".:stiture. 14D 

HILL, E. Jean M. 
Retiring as Dean of the School of Nwsing at Queen's University. 

HINDE, Donna 
Bk" rev". 55N 

HISTOR\ 0." !\Il:RSI"G 
Fow score and ten (Wilkm!<oonJ 26Oc. 13N. 16D 

HOBSO', Joan 
Listening does help: one patient's experience (Winberg) 40S 

Fetal momtormg; why bother? 44Mr 
HOLDER. J. Patricia 
Directtt of Nursmg. The Princess Margaret Hospital (port) 5 I My 

Beller qualified personnel would henefit aged. IOF 
Future for VON despite budget cuts. 7JI 
S[. John/Red Cross multi-media project. 18My 

Sharon Daw. wj.h CARE/MEDICO (port) IlJ. 
Nwse to cluect Informal1on Centre. 12F 

The practice environment as perceived by new graduate nurses 
(Kay) 52N 
The nurse contJDuum perspective (McGee) 24Ja 

We took physical fitness to the county fair (Desai 

'1 al) 25Je 

HlFFMAN. Edythe 
Nam.d 1977 Nur.. of .he by AARN. 40JI 
Hl 'ITER, Margaret M. 
St. John Ambulance Inveslllure 14D 


46Ja. 15F. 29My. 34J.. 51Au. 
ILES, J. Penn} 
Cuddl. bathing can b< fun (McCrary) 24My 
ILLICH. han 
World Federation for Mental Health (Zilm) 100e 

IMAI, H. Roo< 
Duector of professIOnal services 81 CNA (port) 50s 

See Emigration and immigration 


Health happenin
s m the news. 13JI 
I:'ooDl-\'S A'D F$KI\IOS 
HeaJlh happenings m the news. 13Ja 

BoUle holders banned by federal officials. I lOe 
A child hfe program 10 aCllon. 42N 
Cuddl. bathmg can b< fun (lI.s. McCrary) 24My 
The father's side; .II diffcrent perspective on chlldblfih (l..eonard) 
Helping a family and their premarure baby gro"" togerher (Murphy) 
Peter: an infant with a myelomeningocele (Hendry) 15Ja 
Practical guide to preventing neonatal heat loss (Williams. Lancas- 
ter) 28My 
1'Ii."ECTlO'll CO:'ooTROL "'RSFS O. ....E\\ BRl'\S\\Il"K 
Organize. 12D 
Health happerungs m the news. 13Ja 

"FOR\IATIO.... S."R\ICE'i 
Nurse to direct InformatIOn Centre at Hospital fur Su:k Children. 
Idea exchange. a hazard of intravenous therapy - cored panicle" 
(Bessette) 34Je 
INI'oFS, Jean E. 
Bk" r<Y". 54My 
ISSS. Rebecca 
Connecllon (porll 4JMy 

4Ja. 6F. 6Mr. 6Ap. 4My. 4J.. 4JI. 4S. 6Oc. 4N. 4D 
Things that go bump 10 the night (Worthmgtonl 19<Jc' 

International authol'"Îties to address ICEA conference on the family. 

Things thaI go bump m the mght , Worthington) 190c 

I"TER/liATIONAL COL....crL 0." 
Announces 1977 3M Wmners. 16My 
Area members. 50S 
ICN seeks director. 14Au 
Olive E. Ansley. president. 50S 
Rcn nam.d acting ICN hc:ad. 18My 
Verna Huffman Splane. 2nd Vice President (port) 40JI 

"TFR'ATlO"AI COl'lCII OF !\Ill{"
S. BO-\HD O. 
DIRECTORS t977-19Ht 
Officers. 50S 
ISTER"ATIONAL COl 'CII. OF '1l RSES. CO:'oo(;RF_"-" 1977 
CUNSA sending two rq>resentauves. 5 I My 
Heal.h happ<nings. 14Ap 
ICN meets in Tokyo (Suberviola) 6Au 
New horizons for nursing. Part I. 38Au. Part 2. 40Av 
Nine new member assOCiations, Fiji. Mauritius. Puerto RIco. 
Swaziland. St Lucia. Paraguay. Sudan. We!otern Samoa and 
Honduras. 6Au 
PerspeclIve (Hanna) 2Jl 
Represenr.aUves - to the 1977 ICN Congress. 5 I My 
Welcomes student nurses. 8J8 

CNR holds policy session. 9Au 

Outpost nursmg Iß northern Newtoundland (Graydon. Hendry) 

Bellcr working conditions for nurses. 6S 

Hospitalization and personality change recognitiOlJ vital to nur!olß 
care (Lak.) 44Ja 
The nurse continuum perspective (McGeel 24 a 

The nurse conllnuum perspective (t.4cC 

1:'oo"OOD. Marlin 
Hemophiliacs studied. 13 

Special isolatIOn u 


JUiKI:'ooS, Anne 
Director. P 

ARNN launche!!. sta(U:-., !!,tudy. IOJe 

JONfo:S. Arlene Ðraffin 
Chairperson of CTRDA Nurses' Section. 4E!N 


Jenmece Beryl Lar
n. awarded $4.500. 4HS 
k.A \". Gloria 
The practice en \ironment a
 perceived by new graduate nurses. 

Kt'AST. Ron 
Idea exchange; education In the elecunmc age (Escotl) I SF 

M.Sc. (Applied) offered (0 non-nurse,. 131a 

K t':\IP, Isab<lIe 
Provincial repre,en[dllve. Ontario. CCCN. 52Mr 

Kt'RR. J.n.' C. 
Per!lopeclivc (port) E, 4Ap 
KERR. M.rlon 
CNA rep altends world food symposium. 140c 

Bk. rev.. 46JI 

Knowledge reponed by ChroniC renal failure patients In four areas 
related to self-care (Smith) 500c 
A question of balance; the effects of chronic renal failure and 
long-term dialysi!<. (Ford) 19Mr 
KIEREINI. Eunice Muringo 
Nursing practice around the world. Africa, 41Au 

K' KIiOU. Jun. 
Mirroring. 31 Mr 

Pruleclive isolation unit, MOlltrcill Genend Hm.pital. 26Au 

k.OAJ:K. Therese 
Bk. rev.. 47JI 

KOLIEY. Robert. L. 
Lc(.turer, University of Alberta. 160c 

Kl'C1NSKAS. Angel. 
Awarded the Judy Hill Memorial Scholar!!.hip. 48N 
KYLE. Mavi!li Eo 
The development and tC'!!.tin
 of an mslrumenl tor &sessmentand 
cla\slfiCdtlon of pillients by IYpe!!. of Cilre, A, ......D 


LABEI.LE. Huguelle 
Profe!iì...ional responSibility: an Inlernational concern. 38Au 
SRNA diamond jubilee. 811 

B C. nurses join public employees, 13JI 
CNA appoints diredor of Labor Relations Services. 18My 
Glenna Rowsell assumed the new position at CNA House inOttawa 
(pan) 48N ' 
CNA directors hold work ...esslon to consider nursin
Frankly speak1ßg: government for whom.? (Gosselin) 19My 
Perspective (Gilchnst) E. 3My 
Perspective (Hanna) E. 40c 
Separate collective bargaining body for Albena. 1311 

Outpost nursing in norlhern Newfoundland (Graydon. Hendry) 

French b"anslalor at CNA (port) 48Ja 
LAING. Gail Patricia 
0'" .tahz.arion: IS It always a negative experience? 35N 


rrtrud "\-, 

,ahly change: recogmllon vital to nursmg 

, 44 

I A l ""IDfo M..... 

........ li>urn.. 'IN 

I <\MI'>U'R. Marl. 

U1 I istered 

L<\MPF ""..n 

, Barlels. Good) 

Practical guide to preventing neonatal heat loss 'Williams) 28My 

LANTZ. BonDi. 
Director. Surgical Nursing. VGH (port) 8N 
LAPP. Sheryl Ann 
Awarded the Helen McAnhur Canadian Red Cross Fellowship, of 
S3.500. 48S 

LARSON, J.nni... Beryl 
Awardc:d ,he K.'heri.... E. M.cLaggan F"lowship ofS4.500. 48S 
Appointed chairman of the nur!!.ing depl. Mount Roya1 College. 
Calgary Alb<na (pun) 14D 
I.AIIGHARNE, Elizabe'h 
Tri-Hospital dlabete
 education centre: a cost effective. 
cooperative venlure (SIt:Ißer) 14S 

LAII70N. K.'hy 
Appointed execullve-secrclary of CAUSN. l2Je 

LA"OIE. /.ine 
NBARN scholar>hip. 14D 
Prot.c'ion of lif.. 13My 
LAWRANCE, Mi<hael J. 
Appointed 10 the faculty, McMaster. I70c 

The nurse: continuum perspective. 24J8 

LeBLANC. Francine 
Idea exchange (Schultz) 29My 
Why nursing? (Lorree) 30D 
LEJo"ORT, Sandra 
Burn update, 16Au 
Care of the rape victim in emergency. 42F 
Ready for any emergency. 45My 
LEGER. Mi<hellne 
NBARN ,cholarship. 14D 

CUNSA delegates meet in Calgary to examine nursing and the law 
(Parish) 16Mr 
Elhics and the law in practice (Escott) 54Au 
PEl nurses promote changes in property laws. 18My 
Right to di.. 45JI 
LEMIEUX, Louise 
Director. RNAO's nursing process proJCCt underway. 8N 
JOIned ,he starr of the: RNAO. 40JI 

LEONARD, /.ind. 
The father's side; a different perspective on childbirth. 16F 
Husband-father's perceptions of labour and delivery. A, 44Je 
Selected aspects of the child bearing experience. . (Elfert\ A. 

Did you know. . .. 14Au 

L.:WIS, J..n E. 
St John Ambulance Investilure. 140 

Bk. rev.. SOF 

56Ja. 52F. 56Mr. 62Ap. 55My.48J..48JI. 55Au. 56.. 55Oc. 56N. 
LlNDABUR Y. Vlrglni. A. 
Managing editor of two magazmes in Naples. Aorida. 51 My 

Body Image and the cflses 0. enterostomy. 24N 

LlNDQUST, Janel 
Nurse heads N.W.T. Public 
Health Association. 12Ja 

LINQUST, Mabel W. 
St. John Ambulance Investiture. 140 

LITTLE. Dor..n 
Bk. rev.. 54My 

LORREE, Donald J. 
Why nursing? (Leckie) 300 

LYNCH. Mary 
St. John Ambulance Investiture. 14D 


M<ALARY. lU<h.rd 
Needed: a new way of helping. 45Ap 

McC.<\NN. ø...rl.y 
We took physical fitness to the county fair (De

el al) 2.5 

M<CRARY. M.rd. 
Cuddle bathing can be fun (lies) 24My 
B.ha",...1 .herapy. 26J1 
Practical concerns for nursing the elderly in an institutional sellinJ 
McGEE, Arlee D. 
The nurse continuum perspective. 24Ja 
Nursing the alcoholic patienl. 30Je 

McGill Research Unit to srudy community health nursing 9Ja 
M.Sc. (Applied) offered to non-nurses. I3Ja 
Awarded the Jud) Hill Memorial Scholarship. 48N 
Md" OR. 
Flying to work. 34[) 
M<KENNA, Sh.ron 
A qu..' day. . ..201< 
Lecrurer. Queen's University. 160c 

M<KNIGHT. Wendy Lynn 
R.., S2.000 scholarship (port) 48S 
Expanded roles in respiratory nursing - the respiratory nur 
clinician for quality care, 3.5JI 

McLEOD, Mona 
Bk. ..... 510e 
MACLEOD. Vi.;.n 
NBARN ScllOlar>hlp. 14D 
Appointments. 170c 
McMEEKAN. L. Patricia R. 
Frankly speaking: so you want to make a comeback. 26F 
McNEIL. M.deleine 
M.moosh,p s..,..tary. CCCN. 52Mr 
M<NIILTY. M.llhew F. 
NLN elects man as vice-president, 7Je 

M<PHAIL. Irene 
St. John Ambulance Invesl1lure. 14D 

ReproÖJction and the lest rube baby (pakalnis) 34F 

Host first national seminar on 5tandrads of nursin
 practice. 6 
Standards meeting. 90 
Suppons Ak:n. 15Mr 
MANN. Judy 
Second vice-president of NBARN, 95 

NBARN presenls bnef to education committee, 7Je 

MARLATI, Corine 
In Afghanistan wilh MEDICO. 5 I My 
Manitoba nurses study Implications of development of nurSI 
standards. IOJI 
Members back MARN at special mccting. 7N 
Representatives meet with cabinet. 12Mr 
Sets up referral service. 12Ja 

Protective iso1ation unit. Montreal General Hospital. 26Au 

MATSUNO. Klyoko 
Receives a $3.000 scholarship (port) 48S 

MAY, Thelma J. 
St. John Ambulance Invesliture, 14D 

MEAD, Margaret 
World Federation for Mental Heahh draws 2100 concerned 
professionals (Zilm) 100c 

Appointed Regional Director for Ontario of the VON. 49N 

NBARN brief on mental health services, 12S 
World Federation fex Menral Heahh draws 2100 concerned profc, 
sionals (Zilm) IOOe 
Michael Samuel Phillips. appointed deputy direct< 
adminisrralion. 160c 

MID\\ It.EIt\ 
AJ.ernalivc birth centers (Rice. Carty} J IN 

MlKOSM. Christina 
Bk .....5IOe 

Four score and ten (Wilboson) 26Oc. IJN. 16D 

MILLER, Winjl..... M. 
DU"eCtor. PsychlatIlC Nursing. VGH (port) 8N 

.. '=da1)' of Ih. RNANS, 48N 
MILLS. Oalre 
Le<IU...., Uru....."y of Albma. 160c 
MIL TON, 1sab<1 Carolln. 
R.c..... a S3,OOO scholar.hlp (port) 48S 
MO","TEMURO, Ma.....n 
Appoint<:d 10 "'" facullY. McMa...r. 170e 
... New pimary care centre opens in Montreal. 12S 

MOORE. Janel 
Bk. ..... 55N 

MOItGAI'<, Janie< B. 
SI. John Ambulance lu\cstiture. 14D 

Day lherapy centre: lhe rok of the pnmary ewe nurse. SOAp 

God'. 10.. and a lar of bon<)'. 28S 

MlCK. Nancy 
NBARN .cholarship. 14D 
MlLLlGAN, Mary JaM 
D:.rector RNABC. non lJurse appoinree. 14D 

MI:RDOCH. J...n 
Director of the school of nursmg at lhe Halifax Inrlfmary. Halifax.. 
!\IlRPHY. Norma J. 
Helping. family and their premature baby grow together. 425 

MlRTH\, JOlIn 
Dc:ar Mr. RaJabally (Boyl.) 7D 
CNA executivc director receivcs Reo Honaary Fellowship (port) 
Rq>ort 10 m.mb..-.h,p, liMy 
Thirtieth Wor1d Health Assembly In Geneva. SWitzerland (port) 7 JI 

PClce: an infant with a myelomeningocele (Hendry) ISla 


0"..,,,,,. Ob.....ical. Gy_ological VGH (port) 8N 
48Ja. 52Mr, 61Ap, 51My. 12k:, 40Jl. 48S. 16Oc. 48N, 140 
N.uses to complete new health forms. 8Ja 

NlN elects man as 
ice-president. 7Je 

f'oELSOS, J...n 
Sr. John Ambulance In\lesrirutC'. J4D 

Education in health care in as intercultura1 matcrruty serviCC. A. 
Annua:l meeHng. Amencan Assocl3l.ion of Neurosurgica:l Nurses. 
NEVITI, Joyc. 
Bk. ..... 510e 

A wards. 48Ja 
Brief on mental health services. 12S 
George Bergcron. appomted liaison officer. 49N 
Presents brief to education committee. 7Je 
61st annual meetmg. 6S 
Scholarship. 140 
Suppons pro
inci.1 consultant in psychiatnc nursing, 9Ja 

NBARN bncf on mental health services. 12S 

Outpost nursing in IKW1hern Newfoundland (Graydon. HenÒ"y) 

8Ja. IOF, 12Mr. 12Ap, IOMy. 6J.. 7J1. 12Au.6S. 100c. 6N, 8D 
NICHOL, Colla 
Congerutal di.local.d hip. 14JI 
Congemtal dislocated hip: LIM. 18JI 
How do you feci about. . working nights? (Fitzpatrick) 34S 
Id.. ..change (Th. b<lw..n nighland day) (Ford) 46Ja 
NIXON, Margaret 
Heads Manitoba interest group. 14Au 
Nur'lRg around "'" world (Schlorfddl) 44Au 

Fow score and ten: Pan three (Wilkinson) 16D 
Outpost nursmg in nonhero Newfoundland (Graydon. Hendry) 

Ma. Wrighl. honorary m<mb<:r. 140 

Margaret Nix.on heads Manitoba interest group. 14Au 
Outpost nursmg in northern Newfoundland (Graydon. Hendry) 
Personality p-ofiJes ref]cci new malunty. 9S 

CNA directors hold work session to consider nursing directions. 
Frankly speaking: so you want to make a comeback (McKeckan) 
MARN hosts fll'st national seminar on standards of nursing prac- 
Perspecllve (Hanna) E, 4Mr 
The practice en
ironmem as percel
ed by new gra<<::I'ate nurses 
(Kay) 52N 
RNAO's nursing process project underway. 8N 
Standards or Nursing Practice Project. IOD 

Sel up spec.a) inieresl group. 12D 

Accoudabdity: a p-ofessional Impcrati
e (Pouhn) 30F 
Expanded. roles In re5piratory nursing - the clinical nurse 
speci.list: an indi
idu.1 perspecli
e (Rohinson) 35JI 
Expanded roles in re5pintory nursing - the respiratory nurse 
clinician for qu.lity care (Macleod) 3511 
Hospitaliution and personality change: recognition 
care (Lake) 44Ja 
Marutoba nurses study imphcatums of de
elopment of nursing 
standards. Ion 
The DUrslng process. a tool to indi
iduahzed ..:are (Hagar) 380c 
One: genII. man. . . (Wal.h) (port) 56Ap 
e (Hanna) E. 3S 
Pri.acy: u.. forgorl.n ....d (Schullz) 33JI 
A study of continuity of nursing care from the hospital emergency 
room into the home (Perkin) A. 43Je 

See Education 

Ethics and the law in practice. 54Au 
Idea ex.change (Education in the electronic age) (Escott) ISF 

ARNN bnrl, 90 
CCHA guide. IOD 
..It's tmlC: to go home now. .. another look at nursing hones 
(Ford) 31Ap 
N<<d<d: a ,",w way of "'Iping (McAlary) 45Ap 
Accountability; a p-ofessional imperati
e (Poulin) 30F 
A Canawan grad goe. 10 I'" Stalo. (Zin) 460c 
CNA research study re few key changes in nursing employ- 
ment. education patterns since 1966, 12Mr 
Coast-to-coast rCp<Xts mdlcate few nursing po
itlons a
MARN sets up rcferraJ SCT\lice. l2Ja 
c (Hanna) E. 2Ja 

AnoreJlia ncrvosa; a nursing appr08Ch (Butler. Duke. Sro
el) 22Je 
O,d you know . . .. 130e 
H..lth happening. io "'" '"'W', I3JI 
ing to eat; nutrition for senior citizens (GrcnbyJ 42Ap 
Nutrition and the burn patient (Fortier' 30Au 
Nu..illon Canada O<ntal Rq>ort, 110e 


Ahernall\le birth crnter.., (Rice. Carty) llN 
Cuddle bathmg can be fun (lies. McCrary) 24My 
Education m health Care in an mtercultural materrut)' 
(N.m'lz) A. 52N 
The father's side. a different perspeclI\le on ctuldbll'th (Leonard) 
Fetal monitoring: why bother (Hodnett) 44Mr 
ent sllmuli. 140c 
Husband-father's perccpllons of labour and deb
c:ry (Leonard) A. 
Internallonal authorities to address ICEA conference on the fanlily. 
Selected aspects of the ctuldbcaring experience as descnbed by 
.ixty coupl.. (EJI.,." L<ooard) A. 43Je 
E.pecially for you. nur.. (Wdlo" 20My 
Flymg to work (Mchon 34D 
Health happenmgs m the new!;" 13Ja 
N.S. occupallonal health nunes hold 
mmar, 2111 
OGIL\IE, H...I"'r Marion 
Award.d $4,500 10 !><gin d""loral .rudi.. (portj 48S 
OI\,A. Bolly 
o.rector of nursing. Sha
er Hospital for Chcst Dlscase
. 14D 

A program lhal dare. 10 b< (portl (Skellonl 36Mr 
O'LEAItY. !Ioorah A 
Nursmg Consultant. Health Programs Branch of Health and WeI- 
fwe Canada, 48b 
Standards of Nursin
 Practlcc ProJect. IOD 
He31th Standards Dlrectorale or the Hea:lth Progral'l'lS Branch. 
H..lth and W.lfarr Canada (panl 50S 
Heallh happemngs m the news. I3Ja 

O''1EILL, Sboila 
Rounwp of crillcal issues. CNA annual meeting 1977, 8Je 

Phyllis Burgess retll'cd as director of nursmg. SIMy 

Competency Model ProJect. IOD 

Ontario nurses document dechrung standards of care. 14Ap 

OR nur
s hold 10th conference. 7 Je 

Code ofettucs Implememed m Quebec, 13Ja 

Onentallon and Inservlce pro
ral'l'lS for teachen. In Canadldn two- 
year schools of nursing (Field, A. J-ID 

Onhopcdlc nur
s hold education day. 12Ap 

Body image and the Cri
 of enterostomy (li"Jdc:nsmlth) 24N 
Helping young ostomy patients help them
e<> (Tisdale) 3011 
Peop1e with temporary colO'\tomles (Wood. W3t
OnJ 18N 

Ol ELLETIE, Suzann< 
NBARN scholarship, 14D 
OULTO!'<. Judilh 
Pre"dml of NBARN. 9S 

Ol TI'OST M RSlf'oG 
Fow score and ten l Wìlbn,on) 16D 


Coping with pam: strateglcs of se
crely burned children (Sa\-edra) 

PAKALNIS, Lucill. 
ReproductIOn and the test tube bab (.....1 

PALMER, Rac.,.,1 
President. Commonwealth 

A gift oltomorrov. 

CUNSA <l<:1.g 
PASK, Eleanor 'race 
Recen'es S 
Speclali tJ g. 

P ASSn . Iri. 
On the Forensic Nursl"E Commlnee of the RPNA. 481a 

A child life program in actJOn. 4:!N 
Childhood diahctes: the emotional adJustment of parents and child 
(Crosby) 20S 
Hclpl"E young osmmy patients help themselves (Tisdale) 30JI 
H.y. wha. aboo. tll< Iuds? (Alcock; 38N 
Ho'pIEahzauon" IS 11 always a negative CXlXl1cncc'? (Lamg) 53N 
The Juverule diabetic: in or out of conb"ol? lPolowlch. Eillon) 245 
Programmed Icannng: cardiac deprcs!>ants (Warkentin) 30My 
Tn-hosplEaI diahetes educatIOn ccntr
. a cost effective. cooperative 
venture (Laugharne. Stclner) 145 

Consumer rights and nursl"E lStorch) A. S2N 
The development and testmg of an Instrument for ds..e!'i,menl and 
classification of patlcnts by types of care (Kyle) A. 44D 
God's lovc and a jar of honey (Moynihan) 285 
HospiEalization and pasonalily change: recognnion viEaI to nursmg 
care (LakC) 441a 
Nursing the acutely psychotic patient (Bcrezowsky) 23F 
e (Hanna) E. 4Mr 
acy. the forgouen need (5
hultz) 3311 
The !<>elf-care unit. a bridge to the communuy (Bamngton) 39F 
Spouses need nurse!!. too (Sliva) J8D 

PATTE'. Mary E. 
Professional responsibility an internationaJ concern. ICN plenary 
session. 39Au 

The Canadian Institute of Olild Health' a personal responsibility 
(Andrews) 21J1 
A child life prügTaID in action. 4!N 
Cluldhood diahetes the emotional adjustment of parents and child 
(Crosby) 20S 
CO"Eenital dislocated hip (Nichol) 14JI 
Congenital dislocated hip: Lisa (Nichol) IBll 
Coping with pam: strategies of se'\'erely burned children (Savedra) 
D,d you know . . .. 130e 
Early identification of developmental impairments in infants birth 
to mne months of age (Doherty) A. 52N 
Helpi"E a family and their premarure baby grow together (Murphy) 
Helpmg young ostomy patients help themselves (Tisdale) 30ß 
Hey. what about the kids? (Alcock) 3BN 
Hey. what about the kids? - Commentary (Post) 44N 
MlITonng (KikuchI) 31Mr 
 to direct Information Centre at Hospital fa- Sick Olildren. 
The nursl"E process. a tool to individualized care (Hagar) J80c 
Pediatric audiology workshop aids nurses. 12Au 
Peter: an mtant with myelomeningocele (Henæ-y) 151a 
Practical guide to pre\lentmr neonatal heat loss (Wllhams. 
Lancaster) 2BM) 
The rewards of research. cuddle battùng can he fun (lies. McCrary) 

PEPLA l. Hoidegard E. 
Thrn1 vicc-presidcnt of ICN Board of Dlrectcn. 505 

PERC\. Dorothy 
Receives Florence Nightingale award. 8D 

PEKh.IS. Catherine Ann 
A study ot conunuity of nursl"E care from the hospllal emergency 
room 10(0 the home. A. 43Je 

2Ja. 4F. 4Mr. 4Ap. 3My. 3Je. 2J1. 3Au. 3S. 40e. 3N 
Bk rev.. SSOc 

Drug ad watchdog oI1ssumcs responsibility. IOF 
PHILLIPS. Micha.1 Samu.1 
Appolnled deputy dircctor-administratIon. Meb"opoUtan Toronlo 
ForensIc Service. 160c 

I UIII S. rwtrici. A. 
,.... IMEDICO (port) S2Mr 
PH\ AL FlT'1 

I pha
 two. IIJI 

legs and achmg back 


OJI 1Ion. 40Mr 
et al.) 2Sle 

PIC"t"RJ'iG. Edward A. 
VON appomts financial ad...lser (porn IJOe 
P"E. Barbara 
Appointed to the faculty. McMd.!.tcr. IJOe 

Nurse to direcllnformahon Centre at Hospital for Sick Olildren. 

POLO\\ICH. Carol 
The juvenile diabetic: in or out of control? (Elhott) 245 

POST. Shirley 
The Canadian Institute of Oliid Health (Andrews) 21ß 
H.allh happerungs. 12F 
Hey. what about the kids? - Commentary. 44N 

url" A. 
Accountability: a profrssional imperative. 30F 

POL PART. Ther... 
Ro<ording =,.tary. CCCN. S2Mr 
Perspective (Hanna) E. 4F 
PO\\ ERS. Maumn 
Appomted executi\le director of the RNAO (port) 12Je 

NB RNAs set up separate orgamzauon. 105 

Health happerungs. 12F 
Accountability: a professional imperative (Poulin) 30F 
Day therapy ccntre: the role of the primary care nurse (Morlok) 
New primary care centre opens in Montreal. 12S 
The rote of the head nurse 10 primary nursl"E <<Bartels. Good. 
Lampe) 26Mr 
CarlDg for the forenslL patient (Worden) 2IJa 

New honzons for nur!iomg. Part I. ProfessIOnal responsibility. 
Perspective (Hanna) E. 4()ç 

PROYtSE, A. Judith 
Appointed chainnan of the Health Sciences Department. Grant 
MacEwan Commuruty College in Edmonton. AJberta (port) 
I'ROYtSE. Gail A. 
Dc:ar Mr Rajabally.6D 

Anorex.ia nervosa: a nursing approach (Butler. Duke. 5to
el) 22Je 
Care '\'S. custodialism (de Canga
. 36Jc 
Carl"E for the forensic patient. a supportive approach 10 individuaJs 
an conflict with society (Worden) 2IJa 
NBARN supports provlDcial consultant m psychiatric nursmg. 9Ja 
Nursmg the acutely psychotic patient (Berezowsky) 23F 
Psychodrama and the depressed elderly (Burwell1 54Ap 
The self-care unit: a bndge to the commuruty IBarrl"Eton) 39F 

An analysIs of the application of the concept of family-centered 
care 10 pubhc health nursmg visits (Cunningham) A. 4511 
FrankJy speaking: go
ernment fa- whom'! (Gosselin) 19My 
Id<:a e.chang. (L<Blanc. ScIUlI.z) 29M)' 
Murphy'. glu. (Hall) 
Nurse head!!. N.W.T Public HeaJth Associalion. 121a 
Ontario PHN's hold second open forum. 121a 

ATI'G COl "."IL 
H.C nursc::s JOIn public employees. 1311 


Expanded roles in rc:spntory oorsi"E - (he clinicaJ nurse 
specialist: an mdi\llduaJ perspccti
e (Rohinson) 35JI 
Expanded roles in respiratory nursmg (MacLeod) 35JI 
Ontario nurses document declim"E slandards of care. 14Ap 
Quality assurance off to flying 
tar1. 12Au 

Alice J. Baumgart. named Dean. 4011 
Newappomtmcnls. 160c 

QU':'oo. Paula 
NBARN scholarshIp. 
MJa. t4D 


RACINE. Barbara 
Roundup of cntlcol1llssues CNA annual mectrng 1977. Ble 


RAJA BALL\". !\Iohamed H. 
Nursi"E education. JOS 

RA"OCZ\. Mary 
Bk. re
.. 46Je 

RAMOS, Zooida 
Protective isolation unit. Montreal General Hospital, 26Au 

RA ""'r., Lorna 
Bk. ,.,.. SSS 

Few score and ten (Wllbn
on) 16D 
SI. John/Red Cross multi-media project. 18M) 
[)jrectors. non nwse appointees. loID 
Ins Passey on the Forensic Nursi"E Commince of the Regisr:erc. 
Psy(:hiatrlc Nwses' Association. 4BJa 
Marilyn l. Carmack. appolDted assiSUlnt executi\lc directa' (por 
West coast oorscs stage 65th annual RNABC meeting. 12Au 

The nurse's role in health assessment and promotion. 40Mr 

Beuer qualified personnel would henefit aged. IOF 
Joan Mills. appointed executive secretary. 48N 
NS nurses auend 6Btb annual meell"E. 14Au 

Carole Elliott. communications officer. 61Ap 
Citizens' (:ouncil. 6Je 
Louise Lemieux.-Olarles has joined the staff. 40JI 
Margaret Risk. assistant director-practice in the Nursing [)jvislOr 
Mau.-ecn Powers appointed eJl.ecuti
e dIrecta' the RNAO , por I 
Nursing process project underway. BN 
Ontario PHN's hold second open forum. 12Ja 

o\:'ooSl.Al MEETI'oIG 
RNAO delegates prepare now for furure shock. 6Jc 
RNAO delegates prepare now for furure shock. 6Je 

Ins Passey on the Fa-ensic Nursing Comminee. 48Ja 

CNA directa-
 hold wa-k session to con
ldcr nursing directIOn t 

Carl"E for the fa-enslc pallcnt; a supportive approach to mdlvldua I 
10 conflict with society (Worden) 2IJa 
A gift of tomorrow (French) 20JI 

Rt.ID. Laurie Dawn 
es a S3.000 scholarship. 485 

RE:'ooCZ. Sandra A.E. 
Appornted lecrurer m nursing. UNB. 52Mr 

SJI. SOOC. S2N. 44D I 
An analysis of the appliullon of the (:oncepl of famdy-cemere 
care in public health nurslDg \lISltS (Cunmngham) A. 45JI 
CNR hold. policy ....ion. 9.\u 
A comparative study of the self-acceptance of sUIcidal and 
non-suicidal youths eWestwooc:!) A. 43Je 
Consumer rights and nurslDg (Storch) A. 52N 
The contmuing learrung activities of graduates of two dlplon- 
nursing prngrams in Ontario (Anderson) A. 500c I 
Thc development and testing of an IDstlllment for assessment an 
classification of patlCßts by types of care (Kyle) A. 44D ' 
Early identification of developmcntal impainnents in infants birT 
to nine months of agc (Doherty) A. 52N 
Education in health care in an interculrural materruty serviL 
(N.m<IZ) A. S2N 
The effects of (:ontinullY an nurse-pallent assignment among 
selected group of preoperative aormcOfonary bypass patien 
(Rosa' A. 4SJI 
First psoriasis educatIOn and research centre. 9N 
Husband-father's perceptIOns of labour and dch
cry (Leonard) þ. 
Internal cvaluation of an ex.perimental dacum curriculum in 
diploma school of nursing (Halibunon) A. 500c 
Jo-Ann Tippett Fox. Student Research Award from the Canadia 
Foundation for IIcitis and Colitis. 170e 
Knowledge reported by chronic renal failure patients in four arCJ 
related to self-care (Smith) A. 500c 
McGill Research Unit to study community health nursing. 91a 

Onc:nwlon and mKrvice programs for teachers in Canadian two- 
y.. schools 01 .ursing (FI.ld) A. 44D 
postoperallve cardiac surglca] patients' opirnons .bout Slrucrured 
preopcratl'ie leachIng by the oorse (Dumas) A. 44Je 
The practice envl10nment as perceived by new graduatc oorses 
f Kay) S2M 
Rcgma Bohn-Browne. oorses m pnmary care. 17Oe: 
Report or Ibe Task Force on CerviCal Cancer Screemng 
Propmm.s (Ib< W.I.on R.porI) 12Ap 
The reward of research. cuddle balhmg can be fun (lies. '1cCrary) 
S.I",.<<I ""'""ts of ,he: ctuldbeonng "pmence os ckscnb<<! by 
SIXI)' coupl.s (Ell..,. uonord) A. 43). 
A srudy of contmuily of mrsmg c
 from the hospital emergency 
room into the horDe' (Perkm) A. 41Je 
Su("\.ey on nurse researches. 12D 

Expanded roles in reSJJ1ratory nursmg - the chnical nurse 
spcciahS(- an mdividual perspective (Roomson) 3SJI 
EJI;panded roles in resplf310ry nursmg - the respiratO)' nurse 
cliruclan for quality care (MacLeod
"lursing fellowstups otTered. fOS 
RespU1lIory nurses seck. CNA affiliation. IIOc 

RJ CEo AJison 
Alternative both centers (Carty) 3fN 

Bk. ..v.. S3N 

RJSI\. \Iargorel 
Assistant duector-praclace in the Nursmg Division. RNAO. 61Ap 

. MBTY E. (Sally) 
Sum..... ..sickncy a. CNA (pori) 41J1 
O"i. Lft 
Expanded roles in resplfMory nursing - the clinica] nurse 
speclahSl: an mdlvulual perspecnve. JSß 
IROLLS. Barbaro 
o.rector RNABC. non nurse appomlee. 14D 
A. Julia M. P,U,'i.. 
I The effects of contir,uly in nurse-patienl asslgnmenl amoD8 a 
selected group of preoperativc amocOJonary bypass panents. 
RO\\SELL. GI.nna 
DITeCra CNA Laba" RelatIOns Services. 18My.48N 

RO\ . H.I... 
Provincial representative. New Brunswick. CCCN. 52Mr 

CNA CJtccutlVC director receives Rcn Honorary fellowship (port) 
Rcn f.!low named Bermg ICN I><ad. 18My 

0\ o\L \ ICTORJ-\ 1I0!>PITAL. '\I0'TRJ:.AL PALLlATI\ E 
CARE l "T 
HeaJ'h hap".rungs. 12F 

Abortion cou"",!ling (pori) tEastabrook) 28Ja 
R\A', Sbeil. 
Dirc:ctor 01 Nursmg. UBC Med,cal C.n.... o.p, 01 Psyctu.rry. 


ABI:-I,H.J... AARN booonry 9J1 
,T. JOH' A'\1BlLA'CE 
5. Jo/mJR<<I Cross mu"I-m<<lla p-o.l"'" J8My 
A ..w look ar blood IransfuSlon tbc:rapy (Halward) 38My 
A 'IA "iSII.\. :\lar1 
Singing signing snllhng. 28F 

Va] Cloarec. Director or Vital Stallstlcs (pan) S2Mr 

DIamond jubilee celebrates SIJtIy years of growth and progress. 8JI 
Barbano ElI.m..s. E..CUb.. Du-c:ctor (pori) 61Ap 
Mane Lammer. communications officer. 61 Ap 
Perlamance cJtpcctalions of new grads. 1211 
Qualily assurance off fo flying start. 12Au 
Val Ooarec. eJtecutl"c director. resigned (port) 52Mr 

Coping With pain. 2gAu 

CHA '\IBORlKI. IIIII.burg lrsula 
Reccl"C:s a $1.000 scholarship ,port

Commurnly resources for the elderly 47 Ap 

SCHILlI:\G. Kari. >on 
Bk. ..v.. 46JI 

SCHLES"GER. 8<njamin 
From A to Z with adolcscenl seJtua]ity. 340c 

Nursmg around the world. North Amcnca. 44Au 

Appoin..d 10 Ib< loculI)'. Mc'>la"... 170e 
Nwsmg fellowships offered. IOS 

Secondary school oorsmg (Brown) 42Oe: 

Sl. HRl DER, Larry 
Bk ..v.. SSMr 

Icka ..chang. ,uBI.DC) 29My 

Ptwocy. 33JI 
SCH" RR. Tb...... 
o.rector of Nursmg Service. Royal Columbian Ho
pltaJ. New 
\\estmmster. B C. 14D 

SCII \\ ARl. '\tarialUl< 
'1BARN bne! on m<da] heal.h S<fVic.s. 12S 

H.allb happmmg'. 12S 
A school screemng program Ibal works (Gurr) 24D 
SCOTI. J. I\.are. 
Cy'\tlc fibrosis-Camp Couchlchmg. . four summrrs. I.Ue 

SEBlR ,. Isabell. 
Dc:ar Mr Rajabally.7D 

SEGLI'. :\Ianl)n... 
Idea exchange (Education in the clectrOlUc age) (Escon) I SF 

UWO Dean ot l'.ursmg addresses Seneca College Educallon Day. 

Abortion counsc:lJlRg (Easterbrook. RuSl) 28J. 
Care of the rapr "ictim m emergency (LcFm) 42F 
From A to Z with adolescenl sexualily (SchlcsUlger) J
S..uali.y ODd .1>< disabled (Flncb) 19Ja 
SHEA. Juli. A. 
Bk. ..v.. S4N 

SHIELDS. Judith 
Pro"incla] representanve. Bnllsh Columbia. CCC'J'.,.. 5:!

SHIELDS. '\Iary 
Bk. ..v.. SSMr 

A school screening program Ibat works (Gurr) 24D 
SIL \ A. '\Iar) Cipriano 
Spouses need nur.;cs too. 38D 
SI'ICL.-\IR. GI...)c. 
Director of the DIploma Nursmg Program. College of New 
CaI<<Iorua. SIM> 

SKEL TO'. Judith \I. 
A program IJuu dar.s '0 b< diff..... (pori) 36Mr 
FIfSI. psa-iaSIS education and research centre. 9

SLOA'. Halli. 
Nwsmg coordinalor al CNA (port) 40JI 
S\!ALE. Shirl.,. 
ASSlstanl: p-ofessor. Quec:n's Uni"ersll)'. 160c 

S'\IITH. Bonn]. Lee 
Oirecter of 
ursing. Jewish Convalescent Hospnal in Chornedey. 
Laval. Qucl><c. 49N 
S'\!ITH. R....I)n 
DIrector olnursmg. Cñlldren"s Hospital. Vancou,'-er. B.C. 51 \l" 

\UTH. Susan Da""n 
Knowledge reported by chrornc renal failure patients .. A. 500c 

H..llh bIIpp.rungs. 12S 

Alberta nurse educators form new associatIOn. 8Je 
CNA supports SpeCIa] mterest groups. IJOe: 
Highlights from CNA DIrectors' meeting:. 13\1) 

Margaret 'Ixon head!. \tanuoba mteres:l group. 14Au 
'e.. Bruns
ILIc: rnfectJOf'I control J2D 
'ova Scotia nursmg servicc adnllm
trators set up special mterest 
group. I:!D 
Onbop<dic nur.., hold .ooca'ion day. '2Ap 
Respiratory nurses srck. CNA affiliation. IlOe 

Nursmg around the world (Bornlta) 47Au 

SOL THE-\"'T -\'1 \ 
l'.urslng: around the world (de Silva) 46Au 

SO\l E. '!arga..' D. 
Personahty p'ofiles reflect new marunty. 9S 

SP-\LDI'G. J... \\. 
Bk. ..v.. 48JI 

Sp-\RI\.S. F.L. ('am 
Bk .., . 47JI 

A supports special Inlerest groups. 13Oc: 

EJI;panded roles In resplratOl) nursing: - the chnical nurSC' 
speclalisl an mdlvldua] pcrspc:ctJ"e (Rohlnson) J511 
EJtpanded roles in respiratory nursmg - the respiratory nunc 
climcian fer qualify carr f MacLeod) JSJJ 
Speclahzation In nursmg (Pask. 34Mr 

SI8101 sigrun,g smllmg ISamanskJ) .:!8F 

Proc:ecti"c ISoOlallon urnt. \1onneal General HospiEaI. 26Au 

SPITLER. \\al... O. 

ew prunary \.arc centre opens in Montreal f25 

SPL-\ 'E. \ .rnn HulTman 
2nd v,c..Pr."d.,,1 IC'I (porIl 40ß. SOS 
SPROl L. Hea.h.. 
'\lrs Band m< (pori) -I6F 

Ho.. do you 1..1 about working nights? (Fitzpalnck) 345 
Perspective (Hanna) E. 3S 

!>T-\"TO'. CoI.... 
Bk. ..v . SOJa. '\.IOe 
SI-\LF\. Ann G. 
Bk ..v.. '\.1'1 

ST -\LLI\. 'ECHT. I\.its'.. 
Nursmg around the world. Europe. 4JAu 

Tri-h05pnal dlcibetes education centre (uughame) 145 

STOCI\.\\ELL. Carol). 
Cbllorman. CCCN. S

STORCH. Ja.... L. 
Consumer nghls and nunmg. A. 52N 
Su("\.ey on nurse researchcs. I:!D 

STO\ EL. TolÙ 
AnoreJtla nervosa (Butler. Duke) 22Je 

Reured nurses 3Jd elderly m Alberta. 9JI 

STl DE'T!> 
ICN welcomes stufkntllw
s. 8Ja 
'>Irs Band m< (Sproul) 46F 
SlBER\ IOLA. \ i>ja... 
ICN meets in Tokyo. 6Au 

A comparau\-e study of the self-acceptance of suICidal and nOD- 
suIcidal )ouths: l\\cstYoo()(J) A. .UJe 

SlLL!\ -\,. Judi'b 
Personality profiles reflret new malUnly. 9S 

Sl "\ BROOl\. \/EDlC-\L Ct"'TI!E 
Utura", Barr. appolOled a.s.5lstanr eJl;ecub"'e dlfec 
. 48' 


A conference (or supen ISOI" S 
The role of the head II"" n 
Lam".) 26Mr 
Body Image ar 
The effech 
Hdpmg y 


People with temporary colo
tomlcs (Wood. Wat
on, 28N 
Poo.loperati\e cardiac ,urglcal pallems' oplrunn
 aboul strucrured 
preoperdllve tea,-hlng by the nur
e (Dumd
) A. 44Je 
e' need nur,e, too I Silva) 3KD 

Sl n "... K.lh<yn 
cholarshlp. 4tiJa 

S\\ FUE=" 
Needed. a new way of helping (McAlary) 45Ap 
SWI!'\.TO!'l, Constance A. 
On loan '0 CNA f<om CIDA (pocO 41J1 


. Gina 
Provinclid representative. Manitoba. CCCN. 52Mr 

The taxman cometh (Grenby} 36Ja 

TA\LOR, H.I.n 
Montreal nurse heads accreditation body (port) 18My 

Did you know . . l30e 
TISDALE, Hild.go<d 
Helping young ostomy patients help themselves. 30JI 
TOMP",r-;S. Calh.<i... 
Appomted to the fa(.ulty. McMæ.ter. 170c 

NlRSE'i ..."SOllATION 
Orthopedic nur
 hold educdtlOn day. 12Ap 

TlR'BALL. Ma<lha 
Protective I!<.oh:luon urut. Montreal General Hospital. 26Au 

Tl R'BlILL. Sha<on 
Bk. ..v.. 53N 


l :'00101'. Of ...., RSb OF ALBERTA 
Separate collective bargammg body for Alberta. I3JI 

I 'ITEU '1A no'lls 
'Aorld Environment Day - June 5. 1977 (Hanna} E. 3Je 

A Cdnadidn goes to the Sti:ltes (Zm) 460c 

New dppointmenh. 160,- 

Nl R'I'(; 
Mdfllyn D. Willman appointed director. 52Mr 

Announces change
 In nursing program. 12F 

l;\l\ F.RMT\ Of fOROr.TO. EN\ IROr;MEr.TAL AND 
ocn PATlO
Health happeru"Es In the new!<.. 11Ja 

Appolntmenl!<.. 4HJa 

1'111\ ERSI f\ OF \ IrTORIA 
e... on elderly. IIDc 

Dean of Nursing addl-esses Seneca College Education Day. I "iMr 
M Josephine Flaherty resigned a!l.dean. Faculty of Nursing. 
I My 

Dlfeclor. School of Nursing. USC retire,. 52Mr 


Laryngectomee leanet, 48Au 

Reorganizes nursing department. 8N 

Ontario PHN's hold second open forum. 12JI 

St. John Ambulance Investiture. 14D 

AppOints financial adviser (port) 11Oc: 
Future for VON despite budget cuts. 711 
Ruth Mellor. appomted Regional Director for Ontario. 49N 


Awa<ded RNAO F.llowship. 48N 

WALSH. Be.-nadeue 
One gentle man . (porn 56Ap 
WARD. W.ndy 
Protecbve isolallon unit. Montreal General Hospital. 26Au 

Represen[atives - to the 1977 ICN Congress. S I My 
Prognunm<d luming. 30My 
WASSON, Do<oIhy 
NBARN schola<sh,p. 48Ja 
Bk. ..v.. 48JI 

. Pamela Gahe.-in 
People with temporary colostomies (Wood) 28N 
WEARJNG. Joan k.... 
Awarded a $3.000 scholarship. 50S 

Especially for you. nurse. 20My 

Nursmg around thc world (Chung) 45Au 
WEST",OOD. Calhenne Ann 
A comparative study of the self-acceptance of sUIcidal and non- 
sUIcidal youths. A. 43Je 

40J.. 42J1 
WHELAN, GI.ny. A. 
Provincial representative. Newfoundland. CCCN. 52Mr 

Four score and ten. 26Oc. 13N. 16D 


Practical gUide to preventing neonaEaI heat loss (Lancaster) 2tif' 

WILLMAN. Ma<ilyn D. 
Dlfector of the School of Nursing. UBC. 52Mr 
Bk. ..v.. 54N 
T rea.MIrer. CCCN. S2Mr 

WINB'ERt., Muna 
Llstenmg does help 'Hobson) 40S 

New horizon for nursing. Part 2. Nursing practice around 
world. 40Au 
Women in ambulance services. 10Je 

WOOD, Robin Young 
People with temporary colostomies (Watson) 28N 

WOOD, VIvian 
In Wom<n of aclion 1876,1976. 14D 
WOODS, Cuol 
Aword.d RNAO F.llowsh.p. 48N 
Caring for the forensIc patient (pon) 2IJa 

See Congresses 

Draws 2100 concerned professionals (Zilm) WOe 

Thlnieth World Health A
mbly an Geneva. SWitzerland. 7 

Four score and tcn (Wilkmson) 26Oc. 13N 

Things that go bump in the night. 190c 
Honorary m<mb<<. NWTRNA. 14D 


Idea exchange: well woman and health awareness chmc (1:>01. 

Esp<<ially fa- you (Wd'...) 20My 
YOUNG. Olive Ju... 
Assistant professor. University of AlberEa. 160c 

Director. Medical Nursing. VGH (pori) 8N 

Federal transfer health services. 9D 

L.ILM. Glennis 
World Federation for Mental Health draws 2100 concerned pro 
sionals. WOe 

71MMERMAN, Ann. 
Professional responsibility. 40Au 

ZIN. KatherilW 
A Canadian grad goes to the SEates. 460c 

..I.ø @.......-J,.... 

January 1977 

1 ES7607615935 
58 HAR
 APT 3 

 Kl Y 




- , 


c j 






. . 



White Sister wolks hardest 
when you do. 









Style 48505 - Dress 
About $23.00 



Style 8560 
About $35.00 
(Skirt not shown) 

. . 

You work har e IOU 
how much 

h without having to worry about 
our uniform can take. 

And that's the real beauty of the War irober Jf the same fabric. We've paid special attention 
by White Sister. It consists of a jacket, skirt .lnd to sleeve, shoulder and waist design to make 
pants that all work beautifully together, likt two them extra comfortable. White or Robin blue. 
outfits for the price of one. Easy-care "Royall:: Size 3-15. $23.00 
Pristine" fabric. You can wash it, again and a
ain When you want hard-working unif<j"ms 
Looks great with little ironing. White or Robin with a flair for fashion, look for White Si
r by 
blue. Royale's newest colour. Size 6-16. $35 \ WS;Carelle.Aleaderin Canadian career apparel 
White Sister also has a dress uniform made for over 20 years. ......J 
Available at leading department stores and specialty shops across Canada. 


.ho @ø_ødlø_ 


The official journal of the Canadian 
Nurses Association published 
monthly in French and English 


January 1977 

Volume 73, Number 1 


Library Update 


Peter: An Intant with a 
Sexuality and the Disabled 
Caring for the Forensic Patient 
The Nurse Continuum Perspective 
Abortion Counselling 
The Tip of the Iceberg 
The Taxman Cometh 
Crossword Puzzle 
Challenging the Status Ouo 
Hospitalization and 
Personality Change 
Idea Exchange 

Judith M. Hendry 15 
Elizabeth Finch 19 
Jane Worden 21 
Arlee D. McGee 24 
Bonme Easterbrook Beth Rust 28 
Jackie Barber 31 
Mike Grenby 36 
Maria Rubi/ie Glenn 39 
Heather F Clarke 40 
Gertrude M Lake 44 
Lynda Ford 46 






Lifestyle, according to Health and 
Welfare Canada, is .. staying in 
shape or getting fit through regular 
physical activity or it's going to seed.. 
iI's getting out and doing something 
enjoyable or being bored." Our 
cover photo (Courtesy Canadian 
Government Travel Bureau) 
illustrates a form of physical activity 
that is becoming increasingly popular 
with people looking for more exercise 
'n skiing. 


The views expressed In the articles 
are those of the authors and do not 
necessarily replesent the policies of 
the Canadian Nurses Association. 

ISSN 0008-4581 

Indexed In International NUl sing 
Index. Cumulative Index to Nursing 
Litelature. Abstracts of Hospital 
Management Studies. Hospital 
Literature Index. Hospital Abstracts 
Index Medicus The Canadian Nurse 
IS available In mICroform from Xelox 
University Microfilms. Ann Arbor. 
Michigan, 48106. 

The Canadian Nurse welcomes 
suggestions fOl articles or unsolicited 
manusCrIpts. Authors may submit 
fimshed arllcles or a summary of the 
proposed content. Manuscripts should 
be typed double-space. Send original 
and carbon. All articles must be 
submitted for the exclusive use of The 
CanadIan NUrse. A biographical 
statement and return addless should 
accompany all manuscripts. 

 Canadian Nurses Association. 
1::'1 50 The Driveway. Ottawa Canada 
K2P 1 E2. 

SubSCription Rates: Canada one 
year, $8.00: two years. $15.00. 
Foreign: one year. 59.00; two years, 
$1700. Single copies. $1 00 each. 

ake cheques or money orders 
payable to the Canadian NUlses 

Change of Add,ess: Notice should be 
given In advance Include previous 
address as well as new. along with 
registration number. In a provincial! 
territorial nurses association where 
applicable Not responsible for 
journals lost In mall due to errors in 

Postage paid in cash at third class rate 
Montreal, P.O. Permit 1'.10. 10,001. 

 Canadian Nurses Association 


The Canadian Nura. January 1977 

.-e..s 1)"'(. t i'.... 

Usually the start of a new calendar 
year brings with it an almost 
imperceptible rise in spirits. Somehow 
we always expect things to be a litlle 
better in the 12 months ahead. This 
year, however, as the world struggles 
to recover from an economic 
downtum, many people are having 
trouble being optimistic about what 
1977 has in store. Among these 
people who find their expectations 
suddenly and drastically curtailed are 
the members of the Class of '76 - 
upwards of 150,000 young persons 
who graduated last year from 
Canadian universities, community 
colleges and other post-secondary 
institutions. The former editor of 
Canadian Labour, Roy LaBerge, 
writing in the September issue of the 
Labour Gazette, describes the 
employment prospects of this group 
as "possibly the worst facing any 
graduating class since the 1930's 
Depression." Along with the 
Economic Council of Canada and 
Statistics Canada, he holds out little 
hope of improvement in the situation 
until the 1980's. His observation that 
"almost everywhere graduates in 
education, nursing, and several other 

health professions are having trouble 
finding professional openings 
because of government spending 
cutbacks" is not news to nurses. Nor is 
it much consolation to realize that job 
prospects are also bleak for 
accountants, scientists, architects, 
architectural draftsmen, metallurgists, 
biochemists, corporate planners and 
market lesearchers, among others. 
Nor to read that most universities 
report "poor" to "non-existent" job 
prospects for Ph.D's. On page 10 of 
this issue, you can read what some of 
the provincial nurses' associations 
have to report on the Current scarcity 
of nursing positions in their 
jurisdictions. Subjective opinions on a 
'3cattered regional basis are not an 
accurate way to measure 
under-employment but one would 
have to agree with LaBerge when he 
suggests that, at the very least, 
Canada is not tapping the potential 
ability of many graduates. 
Nurses, in common with 
members of other occupational 
groups, invest many years and 
thousands of dollars in preparation for 
a career. When oversupply of 
manpower, personnel cuts and 
reduced turnover make it impossible 
for many of them to find jobs, 
questions inevitably arise about the 

quantity and quality of public 
manpower planning. 
The problems inherent in 
attempts to achieve a balance 
between supply and demand for 
professional and skilled manpower, 
are numerous and extremely complex, 
involving as they do wage rates, 
lengthy lead times, basic forces of 
economic expansion and educational 
planning. Manpower policies must be 
coordinated with other public policies, 
including immigration, regional 
development and science policy. 
It is not enough to simply adjust 
the enrolment in the educational 
institutions in which nurses are 
prepared. "Short run" solutions are 
not the answer. Dorothy Kergin, 
well-known Canadian nurse educator, 
summed it up this way when she 
addressed delegates to the recent 
national conference on the 
professions and public policy: "Before 
manpower planning in the health field 
can be carried out with any 
confidence, we must have a national 
and provincial consensus on what 

kind of health system we are going to 
have and how much we are willing to 
pay for it." She suggested that we 
begin by deciding on the most 
effective way of dividing our limited 
resources among primary care 
services provided by a 
multi-disciplinary team, solo medical 
practitioners, and highly specialized 
institutional services. She went on to 
cite a recent study that showed how 
one ambulatory medical clinic, by 
changing its traditionally organized 
services, was able to cut costs by 
$32,500 per 1,000 patients per year 
simply by complementing physician 
services with care by nurse 
What are the assumptions behind 
our present nursing manpower 
forecasts? Does the answer to better 
utilization of our precious human and 
financial resources not lie in 
fundamental changes within our 
health care system - changes that 
involve allocation of authority and 
responsibility, methods of 
reimbursement and organization of 
delivery of services? Something to 
think about as we enter 1977, isn't it? 


These days, as Alice pointed out, one 
must run very fast simply in order to 
stand still. This month CNJ 
celebrates the first anniversary of its 
new format by updating its cover 
design. We hope you approve. Why 
not drop us a line to let us know how 
you feel about it? 

"Shared labor" is becoming an 
increasingly common occurrence in 
Canadian hospitals and even homes. 
Next month' author Linda Leonard 
describes the reactions of 20 
husbands she interviewed shortly 
after they attended the delivery of their 
latest offspring. "The Father's Side: a 


"\ ' 







different perspective on chi Idbirth" wi II 
offer nurses a litlle mOre insight into 
this aspectoftheir attempts to provide 
family-centered care. 

A number of hospitals in Canada 
admit patients for therapeutic 
abortions. How are the needs of 
these patients for support and birth 
control counselling being met? This 
month author Bonnie Easterbrook 
describes the role of nurses in a 
unique counselling and support 
program available to patients admittea 
to Toronto General Hospital for 
therapeutic abortions. 

Also this month, author Arlee McGee 
shares her thoughts on what nurses 
can do to improve their relationships 
with co-workers and' indirectly, 
contribute to the growth of the 
profession. "The Nurse Continuum 
Perspective," which begins on page 
24, is for every nurse who wants to 
understand herself and the people 
she works with a little better 

M. Anne Hanna 
Assistant Editors 
Lynda Ford 
Sandra LeFort 

Production Assistant 
Mary Lou Downes 
Circulation Manager 
Beryl Darling 
Gerry Kavanaugh 
CNA Executive Director 
Helen K. Mussallem 

. .." 
. .' 





P"ILIP 0 ".....1'1.. 








: I 


8e1mvionú - 
 , , 
I __J CAlIf 



For the newest in treatment, facts, diagnosis- 
your best source (and source of best bargains) is The 
Nurses k Society 

(Publis.....' prim shown) 
THERAPEUTICS. Two eminenTly practical workmg 
guides thai provide the besl o
 currenllmowlc:dge on the 
clinical management of psychlamc comphcatlons. The 2 
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42750. DRUG INTERACfIONS. Third Edition. 
Philip D. Hanslen. Pharm. D. Clinical significance: of 
drug-drug inleraclions and drug effecls on chnlcal 
laboralOry resullS. Soflbound. $11.50 
DIAGNOSIS. Sound advice on ttealmenl plocedures 
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TESTS. Jacques Wallach, M.D. A praclical guide 10 
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64985. NURSING AND THE LAW. 2nd Edition. 
Edilt'd by The HeaI,h Law Cenler and Charles J. Streiff. 
Allorraey-al-Law. Comple,ely covers the nurse's rignlS 
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tion. SIt'phen M. Ayres. M.D. el 01. From basic 
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THROUGH THE LIFE SPAN. Two imponan! books 
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nowledge ,?f the beSI and mosl 
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RESPIRATORY CARE. 2nd Edition. Thomas L. 
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MEMBERSHIP BENEFlTS e In addilion 10 gel- 
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LABORATORY TESTS. Edition 7. Franct's K. Wid- 
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Please accepl my application for membershIp and 
send me the ,hree volumes indicaled. billing me 
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I I I I I 
A few expensive books (noled in book descriptions) 
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Cily Siale _ZIp-- 
(Offer good in Conlinental U.S. and Canada 
Prices slighlly higher in Canada.) Book seleclJons 
purchased for professional purposes may be a laX- 



The Cenedien Nurse Jenuery 1977 

The Canadian NUlse invites youl 
letters. All correspondence is subject 
to editing and must be signed, 
although the author's name may be 
withheld on request. 


Nursing's true spirit 
Thank you for your September 
article - Mary Berglund, Backwoods 
Nurse. In this day of increased 
emphasis on better salaries, working 
conditions, unions, strikes, etc., it's 
refreshing to know that the true spirit of 
nursing still remains alive in the hearts 
of people such as Mary Berglund. 
Her story of dedication and 
unselfishness was appreciated by us 
and we are grateful for the privilege of 
having known Mary Berglund through 
the interpretations of a most sensitive 
author - Ingrid Bergstrom. 
-Francis Ward, Halifax, N.S., Sybil 
Cameron, Middleton, N.S. 

Emergency nursing 
This is to point out the special 
interest arising from your r;1icle on 
Understanding the Patient in 
Emergency that appeared in the 
October 1976 issue. 
Having some experience in the 
emergency ward, I have noticed the 
accuracy of your thinking on the lack of 
communication that exists between 
nurses and patients who are being 
taken care of in the emergency ward. 
Too often, the rapidity with which we 
must take care of a patient prevents us 
from noticing his state of anxiety and 
We give too much importance to 
the physical treatments that must be 
administered promptly and we neglect 
the psychological and emotional 
aspects that have nevertheless an 
important therapeutic value. 
On rereading this article, I have 
resolved to increase the human 
contact I have with patients in the 
emergency ward, as well as with the 
members of their families. For me, the 
emergency ward is the ideal place to 
work; this is the area that I fesl most 
happy in and for this reason I really 
appreciate anything that can help my 
work-particularly with the patients 
- Marie-Marthe Souliere-Roussel, 
Centre-hospitalier Sacre-Coeur, Hull, 

Our mistake... 
In the article Emergency Care of 
the Acute MI in the November issue of 
The Canadian Nurse, the dosage for 
Xylocaine should reae!: Xylocaine drip 
I gm/500 mi. We apologize for our 
typographical error! 

Single pélrenting 
I have just read the November 
issue of The Canadian Nurse and 
again am proud of the credible articles 
this magazine presents to us. I am 
informed and touched with each issue 
but I am writing now in lesponse to the 
article Operation Communication by 
Sharon Bala I commend her integrity 
in accepting and searching for the vital 
aid. essential to the healthy 
development of so many of our 
children who, these days suffer loss. 
I am the mother of six - three 
girls, three boys (five my own - one 
adopted) who was left to "raise, 
develop, and nurture" these children 
11 years ago when the youngest was 
three years of age. I know the personal 
trauma and realize the damage that 
can be done along the way. It is not 
easy but the biggest growth in a 
human being is the realization that you 
have worked and achieved the 
development of your children. I am 
reaping this reward now as I see my 
family as individual, stable and most 
exciting people! 
- Margaret Troyer, (nee Graham), 
M.S.N., Ottawa, Ontario. 

"Upside-Down" readers 
I would like to compliment you on 
your questionnaire, (Oct., 1976) as an 
attem;:Jt to view the problems inherent 
in nursing... We need to know how our 
colleagues feel on various issues. I 
would like to see questionnaires on 
issues such as the input nurses want 
to have as far as health care cutbacks 
etc., which focus on political concerns. 
It seems that nursing is so politically 
detached at the present time - such 
questionnaires may stimulate us to 
focus on meaningful issues again. 
Vancouvei, British Columbia. 

I am very pleased to see such an item 
in our professional journal. At times I 
feel that The Canadian Nurse is 
written solely for and by the 'upper 
crust' of nurses .... For the floor 
nurses, the nurses who work shift, I 
congratulate you for your efforts and 
look forward to seeing the results of 
the questionnaire. 
Etobicoke, Ontario. 

... Would like to offer my 
cor 'Jratulatims to all the people 

involved in getting this magazine off 
the ground, and for the much-needed 
improvement in the last year... 

...this questionnaire shows great 
initiative, and I hope the results will 
have some effect on the thinking of the 
health profession. If The Canadian 
Nurse continues to improve, it will rival 
the best this continent has to offer. 

I hope this isn't just another survey- 
it's high time some GOncrete efforts 
were made to aid all night nurses. 
Thank you. I enjoyed this -let's have 
more of these. 
Lennoxville, Quebec. 

I found your questionnaire velY good, 
except that it seemed to take for 
granted that people do not like working 
nights, as shown by certain 
Editor's note. To these and all the 
hundreds of other readers who took 
time to contribute, not only through 
the questionnaire, but through their 
letters, many thanks. See also this 
month's Idea Exchange on page 46. 
Quality or equality of life 
... I wish to express my concerns 
about some recent medical trends ... 
We work together in one ward to 
terminate a life before birth - most of 
the time, a healthy one. At the same 
time, in an adjacent ward, we 
concentrate on saving a sick, 
handicapped premature baby who 
may need several surgical 
intelventions before ever sitting on his 
mother's lap. 
At least one Canadian hospital 
has switched from saline to 
prostaglandin abortions. This way, the 
baby is usually born alive, appears 
normal for the pregnancy stage, but 
too small to survive. This was 
upsetting to the staff witnessing the 
abortions and some nurses left their 
jobs. The hospital then chose to inject 
blue dye before the abortion. The 
nurses are now less upset because 
babies are blue when born (aborted) 
and look less like candidates for life. 
Where are our standards? We have 
abortions so that only "wanted 
babies" are born, so that their "quality 
of life" is assured. But what if the 
wanted baby, one day, becomes ill, or 

proves to be a "difficult child." Do we 
still want him? 
Am I sure that I am a useful 
citizen; am I wanted by my family? 
Maybe not, yet I hope nobody decides 
to telminate my life just because 
someone doesn't want me around any 
longer. I am a Registered Nurse, but 
- A concerned citizen of Canada, 
(name withheld). 

O.R. experience invaluable 
As head nurses and supervisors 
at a hospital in Eastern Ontario, we are 
concerned about the lack of 
knowledge and skills in relation to the 
basic principles of aseptic technique 
found in today's student nurse or new 
graduate. These remarks in no way 
reflect on the capabilities of the 
instructor or the caliber of the student: 
the students are knowledgeable, alert, 
eager to learn and they too seem 
We feel that O.R. experience is 
invaluable and will reflect on the whole 
future of the nurse, no matter what 
field she chooses to follow. There is 
just no place where this can be truly 
learned except right in the atmosphere 
of the operating room, not just 
standing with your arms folded, but 
listening, learning and above all 
actively participating. 
Please, before it is too late, put 
operating room nursing back into the 
curriculum and let us train interested 
nurses who could become future staff 
nurses or supervisors in our operating 
- O.R. Supervisor, - - Hospital, 
(name withheld). 

Our new look 
...1 have truly enjoyed the last 
three issues of The Canadian Nurse 
(September, October and November) 
and I wanted to let you know. My 
outlook and interest in The Canadian 
Nurse is changing. 
- Cheryl L. Sutton, R.N., Victoria, 
Just a short note to commend you 
on the great improvement in your 
articles. I used to just leaf through The 
Canadian Nurse ... now, each month 
provides a new learning experience. 
Keep up the good work. 
- Dianne Brown, lie des Chenes, 

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The Cenedlen Nurse Jenuary 1977 

I II I) tit 

Dlscrlmlnstlon still exists 
The Advisory Council on the 
Status of Women would like to take 
this opportunity to remind nurses that 
every province in Canada now has 
human rights laws to protect its 
citizens against discrim ination, but the 
federal government continues to delay 
passage of human rights legislation 
that has been promised since 1973. 
The Council points out that, as a result 
ofthis failure to act, discriminationcan 
affect you and members of this 
association. For example: 
If You Are a Member of a 
Minority Group, it means that 
services and accommodation can be 
denied to you because of your race or 
If You Are an Older WOr1<er, it 
means that employers under federal 
jurisdiction - such as banks, 
insurance companies, airlines and 
telephone companies - can legally 
refuse to hire you because of your 
If You Are a Member of a 
Religious Group, it means that 
services and accommodation can 
legally be denied to you because of 
your religion. 
If You Are a Woman, it means 
that you can be denied 
accommodation, services, 
employment, or equal opportunity for 
advancement. It also means that your 
employer can legally provide smaller 
pension and insurance benefits for 
you than for male employees. 
Governments react to pressure 
from the public. If you, and thousands 
of people from across Canada, write to 
urge passage of human rights 
legislation, the government will act. 
You can help by writing today to 
Justice Minister Aon Basford, House 
of Commons, Ottawa, KIA OA6, with a 
copy to your member of parliament. 
(No postage required). 
Sample Letter 
I strongly urge qu ick action by the 
government to pass the federal 
human rights act. I am a member of 
the Canadian Nurses Association 
and I object to the fact that 
discrimination on the basis of race, 
color, religion, age, sex and marital 
status is still legal under federal law. 
- Yvette Rousseau, Chairman, 
Advisory Council on the Status of 
Women, Ottawa. 

Jobs for the older nurse 
There seem to be no job 
opportunities for nurses 50-60 years 
old that would permit us to maintain 
our competency within the limits of our 
strength due to aging. For example, 
'twinning' could be made available. 
Income tax incentives alone make this 
attractive. We can handle four hours' 
work and still have the satisfaction of 
involvement. With health care budget 
cuts, administration should be 
interested in this idea. 
Our experience here and 
overseas makes us valuable. 
Aesponsibility is 'water off a duck's 
back' to us. Disease has changed very 
linle ... neither has basic treatment, 
nor understanding of the patient, nor 
hospital procedures. 
We can cope. Doctors are often 
our age and so are many patients. 
Aapport is good. We are good house 
mothers. Often we are mothers and 
grandmothers. We can handle 
problems. The years have provided 
the answers. 
Often we are given night duty. 
Aging leaves us needing less sleep 
but makes adjusting difficult. On 
changing shifts we have the dubious 
pleasure of a few days of no sleep. 
I know our younger graduates 
need work but the job picture changes 
quickly. Throughout the whole nursing 
spectrum, I would like to see such job 
opportunities provided. 
- Rita Bitten, R.N., Victoria, B.C. 

Did you know ... 
The nursing staff of St. Joseph's 
Hospital in Hamilton, Ontario has 
developed instructional manuals for 
diabetic patients. The manuals, 
entitled An Instructional Aid for the 
Adult Diabetic and So You Have 
Diabetes (A Paediatric Diabetic 
Manual) are intended to reinforce the 
individual teaching provided for 
diabetic childlen and adults. Copies of 
the manual are $1.00 and are 
available from: 
Department of Nursing, St. Joseph s 
Hospital, 50 Charlton Ave. East, 
Hamilton, Ontario, LBN 1Y4. 

Not just an aide 
I am one of many Nurses' Aides in 
Canada. We are responsible for our 
guests in every respect: their health 
habits, cleanliness. comfort, 
contentment. We must be observant 
because we must report to our head 
nurse. so she will know what has been 
going on during that shift. AN's, ANA's 
both have their special magazines and 
books; they have their conventions 
and unions, but what do we have? 
Nothing. We have no say in hospital 
decisions, we have no books, or 
magazines. We are a forgonen part of 
the nursing profession. How many 
mental and nursing homes would 
have to close down for lack of staff if it 
were not for Nurses' Aides? 

I wonder if the professionals and 
the men and women on the board of 
directors ever think that perhaps we 
have a home to keep up, food to buy, 
bills to pay. Maybe our pay check is 
the only one coming in. 
We arenot just Nurses' Aides, we 
are the bridge between the AN's, 
ANA's, doctors and tne patients. We 
are the ones the patients or guests rely 
on, ask things of, depend on. We 
would like to feel that perhaps 
professionals could try to see the 
importance of the wor1< that we do, and 
accept us as a necessary part of the 
nursing profession, not just an aide. 
- (Name withheld), Cumberland 
County, N. S. 

Moving, being married? 
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The Cenadian Nurse January 1977 


Health educators examine 
alternatives to current system 

Health science proglams must 
change radically to provide health 
care workers with the kind of 
education they need to promote and 
adapt to changes in society's use of 
their services. This theme dominated 
the discussion at the Health 
Educators' Meeting dunng the 6th 
Annual Meeting of the Association of 
Canadian Community Colleges, held 
in Ottawa this November. The session 
centered around the problem of 
"Decreasing Enrollment - the 
Dilemma of Health Science 
In confronting the question of 
whether health educators have a 
moral responsibility to decrease 
enrollment in response to decreasing 
need, Jenniece Larsen, chairman of 
the Allied Health Department at Grant 
MacEwan College in Edmonton, 
pointed out that we must distinguish 
between real health needs and 
artificial or created needs which 
depend on the economic climate or on 
government priorities. In our society 
health standards are measured in 
terms of the number of doctors, 
hospitals and hospital beds, not in 
terms of home care, nutrition and our 
approach to geriatrics, and health 
programs tend to reflect this bias, she 
said. She suggested that a better 
question health educators might ask 
themselves is "Do we have a 
continuing need for nurses whose 
expertise is in the hospital?" 
Larsen said that "health 
programs are too restricted in ttJeir 
focus if education is matched to 
specific job needs in society," and 
proposed that what is needed is a 
broad-based education system that 
provides graduates with the 
perspective to assess where needs 
are and the flexibility to change and 
work where they are needed. She 
added that health care workers also 
need to develop political skills to be 
able to lobby more effectively for shifts 
in government emphasis to where 
health needs really are. 

Dr. Sheila Thompson, Director of 
Health Services at Douglas College in 
New Westminster, B.C., also 
addressed herself to the need for 
alternatives in discussing how 
ed!Jcation can change the utilization of 
its graduates. She compared our 
approach of relying heavily on 
credentials to the Chinese approach 
where effort is spent identifying people 
with the qualities needed to perform a 
job well and then training them to do 
that job and only that job. One problem 
with the credential approach is that we 
screen out many students who may 
have a high proportion of the personal 
qualities necessary to be a good nurse 
by requiring that they be able to 
understand and learn things they will 
never use on the job. One way of 
overcoming this problem is to develop 
a core curriculum for all health care 
workers which would provide them 
with the knowledge they can use at 
one level and also with the base to go 
on to higher levels of specialization. If 
this system were adopted, continuing 
education would have a greater and 
greater role to play in career mobility, 
she said. The ideal would be a 
situation in which a licenced practical 
nurse with several years experience 
could move up the ladder to higher 
levels of specialization without starting 
over again, by taking courses to 
upgrade her knowledge and skills. At 
the same time she would be given 
credit for her experience. 
Thompson proposed an 
alternative health care system in 
which clients would consult a 
paraprofessional. someone less 
trained than a doctor, for their basic 
needs. and be referred to a specialist if 
necessary. For this kind of team 
cooperation, medical workers must be 
trained together, she said. 
To deal with problems like this 
that are related to health education in 
the community colleges, the ACCC 
set up a Health Education Resource 
Committee three years ago. One 
continuing problem that has been 
addressed by the committee and 
taken up by a Joint Committee of 
health educators from ACCC and 

AUCC (the Association of Universities 
and Colleges of Canada) is the 
question of accreditation. This 
cooperation has resulted in a major 
proposal to Health and Welfare 
Canada for an independent national 
Council on Accreditation of Health 
Science Educational programs. 

ICN welcomes 
student nurses 

The International Council of Nurses 
has announced that special 
accommodation for student nurses 
will be available during the 16th 
Quadrennial Congress, May 30 to 
June 3 in Tokyo. The Olympics 
Memorial Youth Centre has been set 
aside for the use of student nurses 
during the meeting. 
To be eligible, students must be 
enrolled in an approved school of 
nursing in this country. Registration 
forms for students are available from 
the Canadian Nurses Association and 
must be signed by the president or 
executive director of the CNA. 
The student nurse Congress 
registration fee, as stated on the 
registration form, is U.S. $30. before 
March 1, 1977 and U.S. $50. from 
March 1-31, 1977. No registrations will 
be accepted after March 31, 1977 and 
there is a cancellation fee of U.S. $20. 

Testing Service Committee 
Approves Blueprint 

The Canadian Nurses Association 
Committee on Testing Service has 
placed its stamp of approval on a 
blueprint for a comprehensive 
examination that will eventually 
replace the RN's now written by 
nursing graduates across Canada. 
The blueprint for a comprehensive 
exam, to be made available in both 
French and English, is the work of an 
eight-member CNATS committee set 
up by the Testing Service in 1975. 
Myrtle Kutschke, Blueprint 
Committee chairman, and Michelle 
Charlebois, committee member, 
presented the committee's final report 
to the Committee on Testing Service 
(COTS) at a meeting at CNA House in 
mid-November. COTS members 
voted unanimously to accept the 

The next step in the development 
of the comprehensive exam will be the 
convening of committees to write 
objectives for the blueprint These 
objectives will torm the basis fOl 
development of test items. Four 
objectives committees have alleady 
been appointed for each language. 
Eric G. Parrott, Director of Testing 
Service, says that the first meeting of 
these committees is scheduled for 
January 24-29, 1977, with other 
meetings to follow in February and 

Nurses to complete 
new health forms 

The National Council of the Girl 
Guides of Canada has approved a 
new Health Evaluation form for Girl 
Guides attending activities in Canada 
and the United States which may be 
completed by a registered nurse with 
provision made for referral to a 
physician if necessary. The request 
for a health assessment form which 
could be signed by a registered nurse 
came to the Canadian Nurses 
Association from the National Camp 
Commissioner of the Girl Guides of 
Canada in November 1975. The 
disease-oriented evaluation report 
used at that time was felt to be too 
detailed and required the signature of 
a physican, which during the busy 
summer months was difficult to obtain. 
In response to the request from the 
GGC, the Canadian Nurses 
Association formed a committee of 
nurses skilled in health assessment 
and subsequently developed a 
concise health evaluation form 
designed for total health assessment. 
Only essential information required by 
a registered nurse in completing a 
health evaluation was included. 
This form which must be 
completed three days before a Girl 
Guide attends camp or other activity 
will be in circulation by early spring. 

NBARN supports 
provincial consultant 
in psychiatric nursing 

The New Brunswick Association of 
RegIstered Nurses has pledged full 
support for improving standards of 
mental health and psychiatric care in 
New Brunswick. The Association's 
Council voted in November to request 
government support for a provincial 
consultant in psychiatric nursing. and 
called on all groups concerned to work 
together in upgrading standards. 
The action was taken after 
reviewing a report on the six-month 
advanced course in psychiatric 
nursing held earlier this year. Twelve 
nurses graduated from the course, 
which was co-sponsored by the 
NBARN and the Department of 
NBARN president Simone 
Cormier said that the Council agreed 
with the Report's major 
recommendation for a nurse at the 
government level to upgrade 
psychiatric nursing in New Brunswick. 
Such an appointment would maximize 
the positive strides taken in the field of 
mental health. particularly over the 
past few years. she said. Because 
patients with psychiatric disorders are 
being treated in their own 
communities through such programs 
as community mental health clinics, 
psychiatric units in general hospitals 
and discharge of patients from the 
large provincial institutions to foster 
homes, there is a need for a nurse at 
the government level with expertise in 
mental health/psychiatric nursing 
care. Cormier said. "We see this as a 
priority in the total scheme of providing 
improved services for psychiatric 

Did you know... 
An experimental treatment for 
multiple sclerosis will be tried out on 
eight patients in Toronto soon. The 
patients. who are under 35 years of 
age, who have had MS less than five 
years. and who are expenencing an 
acute relapse, will be given protein 
injections. If these patients are not 
helped. the experiment will end. but if 
results are encouraging. 17 other 
patients will receive the treatment 
before evaluation of the experiment 

McGill Research Unit to study 
community health nursing 

The Research Unit of the School of 
Nursing. McGill University. has been 
awarded a National Health Research 
and Development Award for the 
funding of a Demonstration Project 
involving the establishment of a 
community health nursing service. 
The project. located in a middle 
income suburban community of 
Montreal, is directed toward the 
development and maintenance of 
family health in a primary care setting. 
Some unique features of this 
setting differentiate it from existing 
experiments In community health 
centers. For example. it will serve a 
middle income group as opposed to a 
disadvantaged sector; it will provide a 
nursing service supported by 
community development and 
information services; physicians will 
not be located within the center but will 
be utilized whenever medical 
consultation and/or referral is 
required; emphasis will be placed on 
the workshop nature ofthe setting - a 
place in which people - individuals, 
families and grou ps, will come to work 
on and learn to deal with problems 
related to health. 
As they provide care. in 
collaboration with McGill School of 
Nursing. the nurses involved in the 
project will be exploring, learning and 
demonstrating new ways of nursing 
families and a community toward 
health. In addition. emphasis will be 
placed on the development of a design 
for evaluation. 
The Research Unit at the McGill 
School of Nursing has only recently 
been established and has four nurse 
researchers. seven researchers from 
other disciplines and a number of 
research assistants on staff. Besides 
this community health project. the Unit 
is also investigating the learning of 
health behavior in children. 
Development of the Research 
Unit in nursing and health care permits 
the School of Nursing to offer graduate 
nurses the opportunity to prepare 
themselves as researchers at the 
Master's level. The program is two 
years in length and financial support of 
up to $5.000 per year is available 
through the Research Directorate of 
Health and Welfare Canada 

CNA executive director 
Rcn Honorary 

A Canadian was among ten nurses 
elected by the Royal College of 
Nurses of the United Kingdom to 
receive official recognition during the 
College's Diamond Jubilee Year. 
Helen K. Mussallem. executive 
director of the Canadian Nurses 
Association. was the only nurse from 
outside the United Kingdom to receive 
an Honorary Fellowship from the 
College in a special ceremony in 
London. England on November 24. 


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The occasion marked the first 
time in the 50-year history of the 
College that it exercised its power to 
confer Fellowships and Honorary 
Fellowships in recognition of 
exceptional contributions to the 
advancement ofthe art and science of 
nursing. The Honorary Fellowship 
awarded to Dr. Mussallem was 
conferred by the College in 
recognition of "her work at 
international level in advancing 
nursing education and high standards 
of nursing practice." 
Winifred E. Prentice. immediate 
past president of the Rcn and 

chairman of the committee on 
fellowships. read the citations and 
presented the insignia and scrolls of 
Fellowship or Honorary F
;:owship to 
the recipients. The citation to Dr. 
Mussallem described her as 
"Canada's most distinguished nurse 
in her generation" and pointed out 
that: "She can equally well be 
described as a nurse of the world. so 
generous has she been in accepting 
overseas assignments under the 
aegis of the World Health 
Organization and of other 
governmental and non-governmental 
bodies. also in responding to 
individual calls from the profession in 
various countries wishing to benefit 
from her vast knowledge of nursing 


f j 








education and deep understanding of 
the nursing process:' 
Above. left to right. Catherine 
Hall. Rcn executive secretary, Helen 
Mussallem, and Winifred Prentice are 
pictured following ceremony. Eligibility 
for consideration for Fellowships 
requires nominees to be members of 
the College. actively engaged in 
practice. Honorary Fellowships are 
awarded to Rcn members who have 
retired from practice or to nurses who 
have made an exceptional 
contribution to the advancement of 
nursing at the international level but 
are not eligible for Rcn membership. 


The Cenedlen Nurse Jenuery 1977 


Coast-to-coast reports indicate 
few nursing positions available 

Eight months ago, in May 1976. The 
Canadian Nurse conducted an 
informal survey of CNA member 
associations throughout Canada in an 
attempt to obtain a national overview 
of the nursing manpower situation in 
the various jurisdictions. At that time, 
we reported that the general picture 
was one of tightening up in 
employment prospects, with pockets 
of serious unemployment becoming 
apparent in several centers. In 
anticipation of another wave of 
graduates entering the employment 
picture within a few months, CNJ has 
attempted to up-date information 
presented at that time. Here is what 
spokesmen for the various 
provincial/territorial member 
associations have to report: 

Almost all of the 1976 graduates from 
Newfoundland Schools of Nursing 
have nursing positions (fewer than ten 
do not have jobs). Most of the smaller 
hospitals across the province are 
staffed as budgets permit, but 
hospitals or nursing stations in 
approximately six to eight more 
remote areas of Newfoundland and 
Labrador still require experienced 
nurses. Officials in hospitals outside 
the larger centers report much less 
difficulty this year in obtaining nursing 
staff. There are several nurses listed 
with the Canada Manpower offices 
across the province. 
A total of 30 nurses are presently 
listed as required by employers. Most 
require experienced nurses and most 
are needed in the smaller areas, and 
in extended care facilities. Many ofthe 
part-time positions have been filled by 
full-time personnel. Openings are 
available for public health nurses in a 
few areas. 
Most Schools of Nursing did not 
decrease enrollment of nursing 
students this fall (to any degree) but 
immediate consideration will have to 
be given to this. 

New Brunswick 
As far as job vacancies and nursing 
manpower are concerned, the 

saturation point reached in the spring 
continues to exist. As a result, the 
in-migration of out-of-province (mainly 
Ontario) nurses experienced earlier 
this year has decreased. 
There are a substantial number of 
nurses across the province looking for 
employment through Canada 
Manpower, and hospitals and 
agencies employing nurses continue 
to enjoy a period of adequate staffing. 

Nova Scotia 
In August we had 359 new graduate 
nurses. As far as we can determine, 
167 of these are now employed 
-most in Nova Scotia but some in the 
In June of this year we conducted 
a survey of all our R.NAN.S. 
members who said that they were 
unemployed at the time of registration. 
Considering those on U.1. benefits, our 
Placement applicants, the 
unemployed new graduates and those 
who appear to be unemployed as of 
the June survey, we estimate close to 
800 unemployed nurses in the 
province. The vacancy situation is not 
very good. We only have two 
vacancies in hospitals and nursing 
homes in the month of September. 
Before the restrictions were imposed 
on the hospitals last January, we could 
expect approximately 40 vacancies 
monthly in the metro area. This year 
nurses are hanging on to their jobs 
and as a result, we are not sure if this 
figure will remain the same. 
We do expect approximately 80 
new jobs next spring when two new 
hospitals and two new nursing homes 
open. However, one of the hospitals 
employing approximately 50 nurses 
expects to close. 

The employment situation for nurses 
in Ontario has not changed drastically 
from an oversupply situation. 
The R.N.A.O. Referral Service 
officially began operation on October 
1, 1976 and the first survey to over 
1,100 agencies employing nurses 
indicated that there were 135 

positions available . Of these 
positions, 30 were part-time and 44 
were anticipated openings. General 
hospitals listed 62 positions - 34 at 
the management level and 28 in 
specialty units where special 
preparation was requ ired. There were 
very few openings in Public Health or 
educational facilities. Many of the 
part-time positions were listed in 
Nursing Homes and Homes for the 
Aged. The majority of available 
positions were clustered within the 
larger cities of Ontarió, 
A survey conducted by the 
Ontario Hospital Association in June 
1976 shows that of 1,193 hospitals 
reporting, there were 208 R.N. 
vacancies. However the openings 
were in specialty areas and/or 
requiring nurses with special 
Canada Manpower Centre's data 
indicates that in July 1976, of 1,560 
employees laid off from hospitals, 
70% were registered nurses. A 
program to assist the employers and 
employees was initiated with some 
success. They have found that most 
employees do not have the mobility to 
move to other jobs in other areas, and 
that where the number unemployed is 
high - is also an area or city with few 
or no nursing job opportunities. 
In terms of the approximately 
3,200 new graduates from the College 
of Applied Arts and Technology, 
success rate in finding jobs varies 
from college to college. In 
mid-summer the number with jobs 
ranged anywhere from 7 to 50 
percent, and roughly half of the 
positions accepted were in the United 
Prospects for the next few 
months do not appear to be any 
different. The province is awaiting the 
court's decision on the hospital 
closures, and announcement of 
government policy on financing for 

We know that some of the new 
graduates who wrote CNATS exams 
in August are not employed and that 
for each general staff position, there 
are many applications. We also have 
several administration positions and 
positions in specialty areas not yet 

A more detailed report will be 
available following establishment of 
our referral service 

Employers state that the turnover rate 
of registered nurses is beginning to 
pick up slightly. Vacancies, however, 
are being filled from within the health 
agencies, as part-time and casual 
employees move into permanent 
positions. Applications for 
employment in most situations are 
adequate, the exception being in the 
north of the province, A dearth of 
nurses exists where expertise is 
required, both in education and 
experience. The primary need is 
Intensive Care personnel. 

It is difficult to know accurately the 
supply of nurses in Saskatchewan at 
this time. A brief survey was done at 
the end of September and we found 83 
new graduates unemployed at that 
time. Some of the employed had 
employment in areas other than 
nursing. Like other provinces, we 
believe that some nurses have left and 
others will be leaving to take nursing 
positions in the United States. 
Many nurses who have come into 
the province from other countries have 
had difficulty in passing the 
registration examinations. 
Consequently some of these are now 
unemployed and are having difficulty 
in finding suitable employment. 

Northwest Territories 
In the N.W.T. there are very few jobs 
open. Most hospitals (Inuvik, Hay 
River, Yellowknife, Frobisher, and Ft. 
Smith) seem to be able to meet their 
requirements with ease. The Federal 
government also has very few 
openings in the Nursing Stations. The 
nurses required for the Stations must 
have experience and/or additional 
preparation (i.e. Nurse Practitioner 
We generally fill our staffing 
requirements with applications 
on-hand from interested persons. Few 
of the hospitals advertise for staff. We 
did feel that the number of applicants, 
with good references and with 
experience has increased over the 
last few months. Many are from 
Ontario where the impact of closed 
hospitals must be being felt. 

When you need a reference, choose only the best: 

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(includes the HandbOOk) 
current Drug 

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51 dent Edition: S11.3 3 
5. Order #635&-9. 
,U d EditiOn: $1 . 

. $1. 50 . Order #41ßS- X . 


 833 Oxford Street, Toronto, Ontario M8Z 5T9 

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The Cenedlen Nurse Jenuery 1977 


MARN sets up referral service 
The Manitoba Association of 
Registered Nurses has set up a 
referral service for RN's to assist both 
nurses seeking employment and 
employers seeking nursing staff. 
Health agencies in the province 
are providing the Manitoba 
Association of Registered Nurses with 
up-to-date listings of staff vacancies. 
Registered nurses looking for work 
who contact the MARN office will be 
given a list of vacant positions, and 
may then apply directly to the agency 
of choice. 
The referral service is not a 
placement service and 
recommendations are not proVided 
either to the nurses or to the employer. 
The decision to apply or to hire is left to 
the nurse or the agency. A list of 
several full-time nursing positions 
outside of the city of Winnipeg is now 

Nurse heads N.W.T. 
Public health association 
Janet Lindquist, R.N., who is Nursing 
Consultant for the Northwest 
Territories Health Insurance Service 
was recently elected the fi rst president 
of the N. W. T. Branch of the Canadian 
Public Health Association. The first 
meeting of the branch, with Dr. Ken 
Benson, national president of the 
Canadian Public Health Association in 
attendance, was held immediately 
following the Twelfth Annual Meeting 
of the N.W.T. Hospital Association in 
Hay River, N.W.T. on November 24 
and 25, 1976. The theme of the 
meeting was "The Community Health 
Center' and In conjunction with the 
main session, seminars in Nursing, 
Housekeeping and Dietary Services 
were held. 
Guest speaker at the Nursing 
Seminar was Beverly Rinneard of the 
Scarborough Centenary Hospital in 
Toronto who presented information on 
the Bedside Audit and its relationship 
to nursing standards to about 20 
nurses from Yellowknife, Hay River, 
Ft. Smith, Ft. Simpson and Ft. Rae. 
She also discussed the use of the 
Friesen concept as implemented in 
her hospital and gave assistance to 
the Hay River hospital which is in the 
process of implementing the Friesen 
Concept in the new Health Center. 

Ontario PHN's hold 
second open forum 

Sexually transmitted diseases, 
diseases of the jet age, home births 
and the need for more nursing 
research were the four issues that 
occupied the attention of more than 
100 of Ontario's public health nurses 
at a recent day-long seminar in 
Toronto. The occasion was the 
second open forum for public health 
nurses sponsored by the Registered 
Nurses Association of Ontario. 





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Speakers included Elaine Hykawy 
(above) of the Ontario Ministry of 
Health; Christina Butler (below) of the 
Victorian Order of Nurses of 
Metropolitan Toronto; Gail Wright of 
the Ontario Ministry of Health and 
Joyce Kinslow of the Etobicoke Health 
Unit. Chairman for the event was 
Mar9aret M. Boone. 







Photos counesy Suzame Emond. 

Notice of Annual Meeting of the 
Canadian Nurses Association 

In accordance with By-law Section 44, notice is 
given of an annual meeting to be held 31 March 
1977, commencing at 09:00. This meeting will be 
held at the Chateau Laurier Hotel, Ottawa, 
Ontario. The purpose of the meeting is to conduct 
the business of the Association. 
Ordinary members of the Canadian Nurses 
Association are eligible to attend !he annual 
meeting. Presentation of a current 
provincial/territorial membership card will be 
required for admission. Students of nursing are 
welcome as observers. Proof of enrolment in the 
school of nursing will be required for admission. 
Helen K. Mussallem, Executive Director, 
Canadian Nurses Association. 

International authorities to address 
ICEA conference on the family 

Anthropologist Ashley Montagu heads 
the list of speakers scheduled to 
address the Fifth Canadian Regional 
Conference of the Intemational 
Childbirth Education Association in 
Edmonton in June. The meeting is 
sponsored by the Edmonton 
Childbirth Education Association. 
Concerned professionals and lay 
persons from all across Canada, the 
northwestern U.S.A. and Alaska are 
expected to attend to obtain 
information and insight to help them in 
their own fields. 
The theme of the conference is 
Nurturing the Family. The program will 
incorporate findings from medicine, 
mental health, sociology, and many 
other fields to form an integrated 
approach to the care of the normal 
childbearing family. 
Program participants include, in 
addition to Montagu, who is the author 
of "Touching" and "Life Before Birth": 
Niles Newton, behavioral scientist 
specializing in the psychological 
aspects of child-rearing and 
reproduction; Elizabeth Bing, author, 
childbirth educator and co-founder of 
the American Society for 
Psychoprophylaxis in Obstetrics; 

Agnes Higgins, executive director of 
the Montreal Diet Dispensary; and 
Wilma Marshall ot La Leche League, 
Topics to be discussed during the 
meeting include: early parenting; the 
role of the health care administrator in 
delivering family-centered care; 
overview of modern obstetrical 
practice; drug use; high-risk mothers; 
breastfeeding; meeting the needs of 
native people; temperament of 
babies; obstetrics and the teenager; 
the advisability of adoptees tracing 
their natural parents. 
Lawyers, sociologists, doctors, 
nurses, and psychologists are among 
the professionals expected to 
participate in the conference. 
ICEA is an interdisciplinary 
organization, founded in 1960, 
representing a federation of groups 
and individuals, both parent and 
professional, who share a genuine 
interest in parent education and 
family-centered maternity care. 
The Edmonton Association was 
founded in 1967 and joined the 
International Association in 1974. 

Resolutions for Annual Meeting 
Members who wish to submit resolutions to the 
Canadian Nurses Association annual general 
meeting (31 March 1977) are asked to send them 
to CNA House by 1 February 1977 to ensure 

Helen K. Mussallem, Executive Director. 
Canadian Nurses Association. 

Code of Ethics 
implemented in Quebec 


After two years of intensive work and 
of cor:sultation between members of 
the Order of Nurses of Quebec and the 
Office des professions, nurses in the 
province of Quebec now have their 
own Code of Ethics. The Code was 
conceIved as an effective instrument 
to enable the Order of Nurses of 
Quebec to fully assume its role as the 
protector of the usels of all nursing 
care servICes in Quebec. It came into 
effect at the end of September last 
The following is a list of the 
principal subjects dealt with in the 
. duties and obligations towards 
the pubUc 
e duties-and obligations towards 
e integrity 
. availability and diligence 
. liability 
. independence and disinterest 
. professional secrecy 
. accessibility of records 
. determination and payment of 
. derogatory acts 
. relations with the Order and other 
members of the Order 
e contribution to the advancement 
of the profession. 
The Order of Nurses of Quebec 
invites readers who would like to 
obtain a copy of its Code of Ethics or 
wish to know more about its contents, 
to contact: 
Monique Foisy, Pubfic Relations 
Officer, ONQ, 4200 Dorchester West, 
Montreal, Que. H3Z 1V4. 

Health happenings 
in the news 

An American city- Washington, D.C. 
- has become the first in North 
America to record a higher number of 
legal abortions than births among its 
residents over a 12-month period. The 
human resources department of the 
city of Washington reports that a total 
of 9,819 abortions were performed in 
1975, compared with 9,746 births. 
About 85 percent of the total number 
of abortions were paid for by the 
government Medicaid program for low 
income persons (7,417) or were 
performed without charge at the 
city-operated D.C. General Hospital 

A statistician at the London School of 
Hygiene and Tropical Medicine 
estimates that the risk of death from 
high blood pressure for women using 
oral contraceptives, compared with 
non-users, is 5-to-1. For all 
cardiovascular diseases, the ratio is 
Dr. Valerie Beral, author of the 
study indicating a stronger than 
suspected link between the 
contraceptive pill and diseases of the 
heart and blood vessels, bases her 
findings on an examination of 
morbidity statistics for 21 nations 
provided by the World Health 
She found that as the availability 
of the pill rose, so did deaths due to 
cardiovascular disease in women 
aged 15 to 44. Dr. Beral estimates that 
as many as 200 additional annual 
deaths per million from heart and 
blood vessel diseases among women 
in this age group may stem from use of 
the pill. 

Vaccination of native people in the 
North West Terntones against swine 
flu got underway several weeks ahead 
of centers in the south because of the 
special threat the disease poses in the 
North. Native people, according to the 
territories'chief medical officer, Dr. 
F.J. Co lviii, were isolated and not 
affected by the 1918-19 outbreak of 
swine flu and, also, "have historically 
been vulnerable" to respir:;>tory tract 
infections such as Influenza which is 
frequently followed by lung 
"Northern natives lack protective 
antibodies to help fight off the 
disease," Dr. Colvill said. He added 
the limited hospital capacity in the 
region would require "mass 
evacuations should an epidemic of 
any magnitude develop." 
The vaccine is being made 
available at nursing stations and 
health units throughout the N.W.T. 

While the federal Advisory Council on 
the Status of Women calls existing 
birth planning programs 
"inadequate" and recommends more 
government spending on family 
planning information and services, the 
federal government has been cutting 
back expenditures in this area. 
According to members of the advisory 
council, comprehensive family 
planning must become "a matter of 
high priority" for federal and provincial 
governments, a matter important 
enough to justify increased use of 
public funds. 
the Department of Health and Welfare 
says that the budget for printing and 
distribution of information has been 
cut, that staff has been reduced, and 
that budgets for training and research 
projects in Canada have not 
expanded according to the increase in 
the number of projects. 

A new Environmental and 
Occupational Health Unit is to be set 
up within the Faculty of Medicine of the 
University of Toronto. The goal of the 
unit will be the solution of a wide range 
of health problems caused by 
environmental pollution and the 
effects of industry on the employee. 
The focus will be on research, 
education, information and 
consultative services. 

An Oncotogy Nursing Society, of 
special interest to nurses concerned 
with the variety of modalities of 
treatment of cancer patients, is now 
operating in the greater Montreal area 
The Society is open to all nurses in the 
province of Quebec. 
Its primary goals are: 
! to promote quality care for cancer 
. to act as a support group for one 
another in cancer nursing. 
Officials include: Jennie E. 
MacDonald, RN, head nurse, 
Oncology Day Center, Royal Victoria 
Hospital. (president): Frances 
Murphy, RN. head nurse. Montreal 
Neurological Hospital, 
(vice-president): Heather Dorsey. RN, 
head nurse, Royal Victoria Hospital, 
(secretary); Elizabeth Scott. RN. 
chemotherapy nurse, Queen Mary 
Veterans' Hospital, (treasurer). 
Society president, Jennie E. 
MacDonald, points out that the 
Quebec group is anxious to_otter 
assistance to nurses in at*Ier 
provinces who would like to form a 
similar society. The group also invites 
applications from interested nurses in 
Quebec who have not yet joined the 
Society to contact the president c/o 
the Royal Vlctona Hospital, 687 Pine 
Avenue West, Montreal, Quebec, 
H3A 1-A1. 

M.Sc.(Applied) offered to 

The Kellogg Foundation has awarded 
a grant to the School of Nursing, 
McGill University, to fund a 
new 3-year program offered to 
non-nurses holding a B.A. or B.Sc. 
degree and leading to a Master's 
degree in Nursing. 
The first year is a qualifying year, 
in which students are provided with 
experiences fundamental to the 
practice of nursing. The two final years 
are in the regular M.Sc. (Applied) 
program, in which a broad nursing 
base is developed and refined. Nurse 
licensing examinations are written 
toward the end of the third year. 
Further information about the 
program may be obtained by writing 
to: McGill University, Schoof of 
Nursing, Master's Program, 3506 
University Street, Montreal, P.Q. 

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The Ca
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Style 814 Pantsuit 
Polyester Textured Warp Knit 
White - Blue - Yellow - Ice Mint 
Suggested Retail $28.00 

'. nlforml fC9l1tcml 



Judith M. Hendry 


Myelomeningocele is a 
congenital defect that 
occurs in as many as 
three of every 1,000 
children born. The 
problems facing the 
infant with this 
condition and his 
family are illustrated in 
this case study of one 
nurse's experience in 
caring for Peter and in 
supporting his family. 


an infant with a 




"Is the baby normal?" This IS often the first 
question a mother will ask about her newborn 
child. In the excitement of the event, how 
difficult it is to have to tell the parents that their 
baby is not alright - that he has a serious 
Peter was the firstborn son of 
twenty-two-year-old parents. As with any 
young couple, they had been anxiously 
awaiting the birth of their baby and had 
received no warning that their baby might not 
be normal. Peter was born with a severe 
midlumbar myelomeningocele which 
extended from the second to the fifth lumbar 
vertebrae. Immediately following his birth, he 
was transferred by ambu lance to The Hospital 
for Sick Children, Toronto for better evaluation 
of his condition. His mother stayed in hospital 
for a week before she was able to visit him. 
Specific nursing interventions were 
implemented based on a systematic 
assessment of Peter's physical status and his 
parents' coping abilities. 

Physical Assessment 
Only a few hours after his birth, Peter arrived 
on the surgical infant area where I was 
working. He was in no apparent distress 
although he had mild peripheral cyanosis. His 
vital signs were within normal limits; his pupils 
were equal in size and reacted briskly to light. 
Although his head was not enlarged (a 
circumference of 35 cm), it was significantly 
moulded and the fontanelles were large and 
soft. He had a strong, lusty cry. 
On examination, his skin was soft, clear 
and pink. The myelomeningocele was covered 
by a thin membrane and was oozing a small 
amount of serosanguinous drainage. 
Rooting, sucking and grasping reflexes 
were present. When I stroked Peter's cheek, 
he struggled to turn his head towards me. He 
displayed a good grasp reflex with his fingers 
but his lack of response to the pinprick test 
below the level of the second lumbar vertebra 
indicated that there was no apparent motor or 
sensory function in his lower extremities. The 
hip flexor muscles had some tonus but the 
abductors and extensors of the hip were 
paralyzed. causing flexion, adduction and 
lateral rotation deformities of the hip and 

extension of the legs. A slight rectal prolapse 
indicated poor tonicity of the anal sphincter. He 
was able to void a good stream of urine 
spontaneously, but his bladder was not 
emptying completely and retained 
approximately 10 cc of urine. Peter also had 
bilateral clubfeet with calcaneous, 
equinovarus and "rocker bottom" deformities. 

Less than 12 hours after his birth, after a 
thorough medical! surgical assessment of his 
condition, Peter underwent surgery for repair 
of the myelomeningocele. Under general 
anesthetic, the membrane was excised 
exposing the neural plaque. The meninges 
were sutured over the plaque in the midline, 
and lateral skin flaps were raised and sutured 
over the meninges. Postoperatively, Peter's 
condition was stable and he was nursed prone 
with a dry elastoplast dressing over the 

Associated Problems 
Approximately 80-90% of infants with -1 
myelomeningocele develop hydrocephalus. 4 5 
Tension or fullness of the fontanelles and 
increasing head size are early indicators of the 
increased intracranial pressure associated 
with this condition in infancy. 

Signs of increasing intracranial 
Pressure in Infancy 
.tense or bulging fontanelles 
. restlessness, irritability 
. lethargy 
. increasing head circumference 
.sutures palpably separated 
. vomiting 
.sluggish, unequal response of pupils to light 
.decrease in apical rate 

Thus, it was important to check the tension of 
the fontanelles, pupillary reaction and level of 
consciousness when taking Peter's vital signs. 
His head circumference was assessed daily 
by placing the tape measure snugly around his 
head from the oCciput to the frontal region just 

16 The Canadian Nurse January 1977 

FIGURE 1-- myelomeningocele 


....J , 
t _----; 

. .', :: ----\ 
I : ..,.: 
 : L 1_ ,- 
-4_ . .-, 
I.,.. . ::::": -0 
..' .:.:.:. , ' 
,.' '.::.:. L 2 \ 
. _.' "':'\;:
 f : -=---= 
- 111 te r ve r tebra I 

"':'''-';'':.,,"..:..''''.,: - - - ..., 
I . C (- t ....... . 
L .;:'. ;'.Oy :.;..:.;.,,:.;.; .,.,: "! L 3 ' \ 
\. '::2:
t - - - - 
.'. '" '
'. . . \ -.:.. :
 l. 4 \ 
I "
. \ ,=..:.' 
:) ':". l 
Ii.' &.. 
7 :5,/' \ 

- veT tebral body 




CS F -- 

- sacnlln 





veT tebrcll 

___IJJ AryS
 f RS!.. _
E f2! .LO N 



illustratIons courtesy of Shirley Mohyudden 

above the eyebrows. There were no signs of 
increasing intracranial pressure until three 
weeks postoperatively, when the 
circumference of Peter's head increased from 
35 to 39 cm. The fontanelles became full and 
bulging and the sagittal sutures were widely 
separated. Alsoatthis time, he began vomiting 
small amounts after each feeding. 
For the second time in three weeks, Peter 
had surgery. To control the developing 
hydrocephalus, a ventriculoperitoneal shunt 
with a Pudenz. pump was inserted (see 
Figure 2.) 

Nursing Care 
One of the most important nursing 
observations on Peter's return to the ward was 
the assessment of his neurological status. He 
was observed carefully for signs of increasing 
intracranial pressure in order to detect a 
possible malfunction of the shunt. 
Positioning Peter comfortably was a 
challenge. He appeared to be most 
comfortable in the prone position with his head 
to the left side and a folded diaper placed 
between his legs. This position prevented 
pressure on the myelomeningocele incision, 
controlled the flexion, adduction and 
subluxation of the hips, and prevented 
pressure on the skin over the Pudenz pump. 
Since Peter was unable to lift his head due to 
its increased weight, the nursing staff turned 
his head every two hours to the right side for 
. 10-20 minutes to prevent stiffness of the 
sternocleidomastoid muscles. 
.he skin around the ear was massaged 
with cream each time his head was turned to 
prevent skin breakdown. Other areas such as 
the elbows, knees and feet were also 
massaged frequently to facilitate the 
circulation of nutrients and the removal of 
waste products by the bloodstream. To 
enhance this process and to prevent stiffness 
and contractu res, the upper extremities were 
exercised through their full range of motion. 
Extending Peter's arms well above his head 
was especially helpful in preventing shoulder 
stiffness. Because of his lower limb paralysis, 
it was important that Peter's legs and feet be 
exercised gently. This was done with extreme 
caution since the bones of these infants tend to 
be fragile and rough handling can cause 
fractures. 6 Approximately 2-3 of flexion was 
achieved with passive exercise of the knees. 
Passive foot exercises included dorsittexion, 
plantarflexion, eversion and inversion. 
Since Peter could not yet be held or 
cuddled and his condition necessitated that he 
lie in a prone position, the nursing staff utilized 
every opportunity to provide him with 
sensory-motor stimulation and "people 
contact." Thus, exercise periods, for example, 
would be turned into a game where the nurse 
established eye-contact, and talked to and 
played with Peter. This provided some visual 
and auditory stimuli which otherwise were 
limited to those in his hospital room. Playing a 
radio or a wind-up music box provided variety 
in sound stimulation as did singing and talking 
to him. A bright red rattle suspended from the 
crib rail at eye level provided him with another 



Vèntriculo peritoneal shunt 









developmental stimulus. 
Peter had difficulty in taking all his formula 
while in the prone position. We found it best to 
feed him every three hours rather than every 
four hours and give him one ounce of formula 
less each time to increase his fluid and caloric 
intake. Placing my left hand under the infant's 
upper chest, neck and head helped to raise 
him sufficiently to facilitate feeding. Stroking 
his cheek and massaging the muscles used in 
sucking also helped to improve his swallowing. 
The use of a small-holed nipple prevented 
Peter from swallowing excessive amounts of 
air. After each ounce offormula, I stopped and 
gently rubbed Peter's back for a few minutes 
while keeping his head and chest slightly 
As soon as the repaired 
myelomeningocele was well healed, Peter 
could be held during his feedings. This not only 
provided variety, stimulation and security for 
him, but was also conducive to improved 
integumentary and respiratory status. 
Due to the level and extent of his 
defect, Peter had a neurogenic bowel and 
bladder. Sacral nerve involvement interrupted 
the reflexes essential for micturition and 
affected the levator ani and external anal 
sphincter musculature causing decreased 
tonicity of the anal sphincter. 
Elimination of urine was facilitated by the 
Crede maneuver (application of suprapubic 
pressure over the bladder).7 This was 
accomplished by standing at the foot of the crib 
and grasping the infant s hips with both hands 
so that the thumbs extended along the 
buttocks and pointed toward the infant's head. 
The bladder was compressed firmly between 
the first two fingers and the spine. Pressure was 
maintained until the flow of urine ceased. 
Although Peter voided spontaneously between 
bladder expressions, this procedure was 
repeated every two hours in order to prevent 



"gllt lateral 
venti icle 





3rd vent"cle 


=> 0 
<.> .. 
'- 0 



Ð .. 

- ., 
- 0 
- 0:: 
" '" 
:;:; (J 
II> E 






- umbilicus 


incomplete emptying and subsequent urinary 
tract infections. A folded diaper under the chest 
and upper abdomen and a small disposable cup 
under the perineal area facilitated the collection 
process. After each expression, the amount and 
characteristics of the urine were observed and 
recorded accurately and the perineal area was 
cleaned thoroughly. 
With a neurogenic bowel, constipation 
can occur easily due to a lack of normal 
contractile tonus in the lower bowel and 
rectum. It was important that Peter not become 
constipated because it could result in 
compression of the peritoneal end of the 
ventriculoperitoneal shunt and eventually 
cause it to block. Therefore, the characteristics 
and amount of stool were carefully recorded. 
Members of the health team including 
physiotherapist, social worker, public health 
nurse, and hospital nurses met as a group to 
plan for Peter's care and discharge. Realistic 
goals were establis hed early in order to ensure 
that potential problems were not overlooked 
For Peter, these goals were to: 
. take 90 cc at each feeding 
. have adequate daily output of urine and 
. remain free of infection 
. sit In a baby seat 
. go home with his parents. 
For Peter's parents. the agreed upon goals 
were to: 
. feed Peter 
. hold him 
. bathe him 
. express his bladder 
. disempact his rectum 
. exercise his extremities 
. pump ventriculoperitoneal shunt if 
. know early signs of intracranial pressure 
. know adequate inputs and outputs 
. know appropriate stimulation for him 
. feel confident in caring for him. 


The Cenadlan Nurse January 1977 

The public health nurse provided a liaison 
between the hospital and the home and helped 
to communicate these goals to the nurse in the 

Peter's Family 
Helping parents face and cope with the reality of 
a newbom child with a severe defect is a difficult 
task but one which is of utmost importance. 
Peter's parents had not anticipated the birth of an 
abnormal infant and they felt grief for the healthy 
baby they had expected and guilt that they might 
have done something wrong to cause the 
defect. 89 During the first week after Peter's 
birth, neither parent came to see him. His 
mother was still in hospital in the postpartum 
unit and his father was torn between visiting 
his wife or Peter who was in a different 
hospital. He decided to spend his time with his 
wife because she was upset and he thought 
she needed his support. 
Seven days after their baby was born, 
they came together to visit Peter for the first 
time. Both parents were anxious and 
concerned about their baby's condition but 
expressed this in very different ways. Peter's 
mother tried to deny the severity of his 
condition and stressed to her husband how 
'healthy' and 'happy' Peter looked. Although 
she had been told a bout Peter's paralysis, she 
"normalized" his immobility by saying,"He's 
such a good baby. He never squirms. He 
seems to be contented to lie in that position all 
the time." Peter's father was very quiet during 
his first few visits and lookea away each time I 
approached him. Becausð r,is first language 
was Greek, he seemed to be unsure of his 
ability to share his concerns. An interpreter 
helped a great deal to clarify things for him and 
to make him feel more comfortable. One day, 
when talking to a physician he became very 
angry stating that his son's defect was all "the 
doctor's fault." This was the first time he had 
verbally expressed any of his feelings about 
Peter's condition. 
Building up a relationship based on trust 
between the nurse and the parents was an 
essential beginning in helping them cope with 
their new situation. To accomplish this, I 
answered their questions honestly and gently, 
and demoostrated, by my frequent presence, my 
acceptance of them and their baby. 
It was helpful to call Peter by name and to 
refer to "you and Peter" as a umt when I ta,ked 
with the parents. This simple Intervention 
assisted them in linking thems- ves with their 
child in their planning for their lulure. By 
example, I encouraged them to touch Peter, to 
play with him. and to sing and talk to him. 
These "parenting" activities were difficult for 
them, however, because they were afraid of 
"harming" their baby. I tried to emphasize 
Peter's healthy behavior as much as possible, 
for example, taking all of his feeding; 
gradually, the parents were eble to touch Peter 
while talking and playing with him. This 
behavior as well as the parents' questions 
about Peter's feeding patterns indicated that 
they were ready to learn some techniques 
about caring for their baby. 

In my initial interviews with the family, I 
discovered that the parents' knowledge of 
baby care was limited. Both parents were the 
youngest in their families and neither had any 
experience holding, bathing or feeding an 
Our teaching-learning sessions were 
directed towards meeting the goals set by the 
health team, and began with informal 
demonstration-discussions of Peter's feeding 
behaviors, and moved the next day into 
supervised feeding periods initiated by the 
mother. Sympathetic and understanding 
teaching and positive feedback about 
successes assisted her in gaining confidence 
in her own mothering abilities. 
The parents had many new skills to learn 
before they would be ready to care for Peter at 
home. These included how to hold and bathe 
Peter, how to detect early signs of intracranial 
pressure, express his bladder, disempact his 
rectum, determine adequate intake and 
output, exercise his extremities and position him 
Each learning need or problem was 
assessed by the nursing staff in a systematic 
manner by being alert to verbal and nonverbal 
cues from the parents and evaluating their 
developing knowledge base, skills and 
readiness to pursue the task. For example, I 
noticed that Peter's mother tightened her facial 
muscles while she was expressing Peter's 
bladder. When I asked her about this, she said 
that she felt tense and worried about the 
procedure. By placing my fingers over hers 
and pressing down on the bladder with her, 
she was able to judge the pressure required to 
empty the bladaer and felt more confident 
about doing this task. 
With practice, botn parents gained skill in 
assessing Peter's problems and in performing 
the techniques necessary in his care. Before 
Peter's aischarge, they feltthey could carry-out 
the basic daily tasks required. They will still 
have to adjust their usual daily activities to 
include this rigorous regimen without 
redirecting their goals completely when they 
take Peter home. 

Concern for the Future 
For this family there will be many future 
concerns and stressors. There are still many 
questions they may want answered (Le. How 
c"ln we provide Peter with appropr;ate 
stimulation as he develops? What type of 
schooling WOL.ld be most appropriate for him? 
How can we help n;n; find plaýmates?) The 
C0mmumty nurse with me help of the public 
health nurse from the Society for Crippled 
Children can provide guidance to assist the 
parents to prepare for problems associated 
with Peter's development. At the present time 
there is no special equipment required for 
Peter's care. As he grows, he will probably 
require special carts for mobility, wheelchairs, 
braces, orthopedic shoes and urinary 
appliances. The PUblic r,ealth nurse in 
collaboration with other members of the health 
team can assist the family to adapt to each 
new situation. 

Peter will be further assessed in the 
combined spina bifida clinic at the Ontario 
Crippled Children's Centre. Then he will have 
ongoing assessments (Le. urological, 
orthopedic. physical medicine and 
neurological) at three to six-month intervals as 
The family was also referred to the Spina 
Bifida Association which promotes the welfare 
of individuals with spina bifida and their 
families and provides support through a group 
approach to problem-solving. 

Caring for a child with a myelomeningocele is 
not a task that one person can accomplish on 
his own. An interdisciplinary team approach, 
early parental involvement in the baby's care, 
a thorough knowledge of community 
resources, and parental understanding of the 
long range implications will greatly influence 
a!1d affect Peter's early years. With support 
from both professionals and relatives and 
friends, it is hoped that they will develop a 
positive attitude to this challenge and continue 
to demonstrate their love and concern for 
Peter. '" 


Judith M. Hendry (R.N., Hospital for Sick 
Children, Toronto; B.Sc.N., University of 
Toronto; M.Sc.N., University of Westem 
Ontario) is presently a lecturer at the 
University of Toronto, Faculty of Nursing. She 
prepared this paper while working on a 
surgical infant area at the Hospital for Sick 
Children in Toronto. 

1 Kapila, Leela. Surgical aspects. Nurs TImes 
69:6:172-174, Feb. 8, 1973. 
2 Downey, John A. The child with disabling 
illness: principles of rehabilitation, by... and Niels L. 
Low. Toronto, Saunders. 1974. p. 132. 
3 Kapila, op. cit. 
4 Waechter. Eugenia H. The birth of an 
exceptional child. Nurs. Forum 9:2:202-216, Feb. 
5 Lavoie, Donnajeanne. Spina BiMa: 
immediate concerns ... long terms goals, by... et al. 
Nursing '73 3:10: 43-47, Oct. 1973. 
6 Bonine, Gladys N. The myelodysplastic child 
and home care. Amer. J. Nurs. 69:3:541-544, Mar. 
7 COlliss, Virginia. Nursing care. Nurs. Times 
69:6:174-175, Feb. 8,1973. 
8 Bradley, Rachel. A spina biMa baby. Nurs. 
Times 68:5:145-147, Feb. 3. 1972. 
9 Hill, Margaret L. The myelodysplastic child: 
bowel and bladder control, by... etal.Amer. J. Nurs. 
69.3:545-550, Mar. 1969. 











In recent years much literature and discussion 
has centered on hu man sexuality, Society has 
pried into, questioned, evaluated and 
generally exposed to public view, many areas 
of human sexual needs and behavior that were 
once considered taboo. Ideally, this kind of 
scrutiny leads to increased knowledge about 
what it means to be fully "human:' 
For the handicapped person, the journey 
towards a better understanding of his/her 
sexual potential has been a little slower in 
getting started. Igno
ance about the sexual 
feelings of the handicapped person has kept 
the subject shrouded in embarrassment and 
silence but attitudes are changing, Workshops 
and conferences being held in centers across 
Canada are one means of increasing 
communication amonq health care workers 
and the disabled. This ensures that better sex 
education and counselling is available as well 
as providing a means of improving public 
education and understanding of the disabled 
person and his needs. 
An example of this type of conference was 
the one held some time ago at the Royal 
Ottawa Hospital and co-sponsored by 
Algonquin College in Ottawa and S IECCAN 
(Sex Information and Education Council of 
Canada). The three-day conference, entitled 
'Sexuality and the Disabled,' brought together 
health care workers and physically disabled 
persons in a relaxed and accepting 
atmosphere to consider human sexuality in its 
broadest sense and to study the more 
particular diffÍl.,ulties experienced by the 
disabled in the expression of their sexuality. 
The tone for this Ottawa workshop was 
set during the opening address by Beverley 
Thomas, Executive Director of Planned 
Parenthood British Columbia. Beverley is a 
quadriplegic who twenty years ago sustained 
a spinal cord injury as a result of a diving 

ident. With a mixture of gentle humor and 
'Candid self -disclosure, she opened the door to 
the forbidden area of sexuality and made it 
possible for those present to begin taking a 
long, hard look at their own values and beliefs, 
as well as the taboos, myths and 
misconceptions surrounding sexuality in 
general and sexual practice in particular. She 
told her audience: 

I don't want to be the odd guy out. We're 
people and that's important. Because I have 
to wheel to get from here to there is nobody's 
business but mine. But we do have to pick up 
some people on the way who will share that 
experience with us - we have to find those 
people who will love us for ourselves, and not 
worry about those who can't .., in any 
experience where you are trying to create 
trust. you have to take risks. 

By being together in both large and small 
groups, those at the workshop were able to 
exchange information, opinions and 
experiences with one another. For example, 
participants engaged in some value 
clarification strategies which allowed them to 
look in some depth at their own attitudes 

towards sexuality. In order to understand what 
this exercise involved, imagine yourself in a 
small group setting. You are given a small card 
on one side of which is written a general 
statement about sexuality. You are asked to 
respond to the statement. Then turning the 
card over, you are asked to respond to a more 
specific statement. You may elect to pass if 
you wish and no one may interrupt you until 
you finish. Suppose your first statement is: 
Physicafly handicapped children should 
be given opportunities to develop their own 
sexual feelings realizing that they may not get 
these opportunities as other children do. 
More than likely you are able to comment 
on the statement with a fair degree of ease. 
But, how about the reverse side? 
Your 73-year-old niece tells you that a 
close girlfriend. who IS unable to use her 
hands, has asked for assistance in 
masturbating because she wants to find out 
how it feels. She asks you if you think it would 
be OK." 
This IS not quite so easy. Although some 
participants thought the whole exercise too' 
academic, it did permit those unaccustomed to 
speaking freely about sexual matters the 
freedom to do so in an atmosphere that was 
accepting and nonjudgmental. This attitude 
was an outstanding feature of the conference. 
No one felt pressured to talk about their own 
sexual experience if they did not wish to do so. 
In group sessions, participants -r) 
considered sexuality in its broadest sense,a . 
well as examining the importance of 
establishing meaningful relationships - 
"How I view myself as a man or a woman?" 
-"How can I express my masculinity or 
femininity in ways acceptable to myself and my 
partner?" . 
One gentleman, who has multiple 
sclerosis and is confined to a wheelchair, 
shared the following: 

My sexuality consists of more than my 
genitals. For many of us here, they don't work 
anymore. Touching and holdmg someone I 
care for is important to me. Why, I can have a 
spiritual orgasm just looking into my partner's 

A woman participant recounted her 
determination to look just as attractive and 
feminine as any other woman: 

By golly, when I went out to the Queen 
Elizabeth (theatre) and for dinner, I was going 
to wear a long dress just like anyone else, I 
was going to get there, I was going to wheel 
up to that table and I was going to ask the 
waiter to cut my meat. 

This kind of sharing not only provided 
much needed encouragement to other 
disabled people but also helped to dispel the 
misconception that sexuality is synonymous 
with sexual intercourse. As McRae and 
Henderson state: 


The Canadian Nurse January 1977 

Sexuality has many modes of expression, 
ranging from the baking of an apple pie for a 
loved one to sharing one's body. Sexual 
behavior is a private affair between partners, 
having variable sIgnificance depending upon 
the psychologic, physical and social 
environment of the moment. 1 

A variety of discussion groups centered 
on the specific problems experienced by 
individuals with different physical disabilities or 
dysfunctions. Knowledge related to sexual 
activity for people with pain and joint stiffness, 
speech and communication disorders, 
spasticity, muscle weakness and immobility 
was shared by the participants who were 
encouraged to choose the group best suited to 
their needs. Resource people for each group 
included a leader having special knowledge of 
the particular disability and a facilitator to 
provide support and promote meaningful 
interaction between members. 
A panel discussion, "Growing Up with a 
Disability and Learning to Live with a 
Disability," was presented by four disabled 
people who shared where they "were at" in 
terms of their own sexuality and how they got 
!here. The courage and determination of these 
people who shared some of the most intimate 
and what, for most of us, would be devastating, 
experiences i" their lives was greatly admired 
by the audience. 

Conference Outcome 
Effective workshops and conferences 
have a tendency to raise more questions than 
.hey answer and this one was no exception. 
The final sessions were devoted to formulating 
the questions and common concerns of the 
participants into meaningful 
recommendations. A total of 22 
recommendations were accepted for 
circulation to provincial and federal 
government agencies, health care and 
residential agencies, and health education 
institutions within the Ottawa area. 
Participants agreed that: 
. directors and supervisors of health and 
residential facilities should 
- allow self-governing by the disabled 
persons in all non-medical matters, 
- provide appropriate facilities, such as a 
furnished room with adequate privacy for 
personal use by residents on request. 
. an ombudsman (priority to a disabled 
person) should be appointed to be the liaison 
between the associations of the disabled and 
the government (federal and provincial). 
. all in-patients and out-patients should be 
given instructions about the effects of drugs on 
their sexuality. 
. a sexual therapy team should be 
identified within all Rehabilitation units in 
. subsidized transportation should be 
made available to the disabled to allow for 
. disabled children should be integrated 
with other children throughout the general 
school system. 

. all educational programs for health care 
professionals (including inservice) should 
provide courses in sexuality, and sexuality and 
the disabled. 
. institutions and places of care (i.e. active 
treatment hospitals, chronic hospitals and 
homes for the elderly) should allow individuals 
to express their right to privacy and support the 
individual's dignity in this expression. 
To devise strategies for implementing 
these and other recommendations for change, 
a core group of thirty-five people from the 
workshop continue to meet and evaluate their 
progress. They anticipate that through public 
education and a better understanding of 
human sexuality the needs of the disabled in 
the expression of his sexuality will be met. 

Nursing Implications 
During the course of the conference, 
participants became increasingly aware of the 
significance of the observation by one of the 
workshop organizers that: 

The fundamental issues relating to 
human sexuality encompass personal value 
systems, life-styles, self-image and 
communication mode as well as how peoplé 
in relationships act toward each other. 2 

Acceptance of the idea that these words 
apply, not just to the patient - the other guy- 
but also to nurses themselves, carries with it 
severa.l important implications among them: 
. Our sexuality is not out there somewhere, 
it is an integral part of our total being. It is not 
just something we do privately. It is our 
confirmation of ourselves. 
. Until we are comfortable with our own 
sexuality, we cannot help anyone else. Being 
comfortable for some may simply mean that 
when a patient broaches the subject of 
sexuality, you, his nurse, can honestly say, "I 
find it difficult to talk about intimate matters of 
this nature, but I know it is important to you and 
I will put you in touch with someone who can 
help you with this concern." 
. We don t all have to be counsellors on 
sexuality but we do have a responsibility to our 
An individual who undergoes an 
alternation in body image is certainly going to 
have concerns regarding his sexuality. The 
nurse, in helping her patient through the 
rehabilitation process, can encourage the 
patient to take the initial risks required in trying 
out his "new image" as he relates to his friends 
and loved ones, and in making new 
acquaintances. Some individuals have to 
learn to love all over again. 
This demands a lot of courage as well as a 
great deal of support from the health care 
worker most closely involved, the nurse. 
Therefore, we must become as 
knowledgeable and as comfortable as 
possible in this whole area if we are to be of 
help to the disabled person... 

1 MacRae, Isabel. Sexuality and irreversible 
health limitations, by... and Gloria Henderson. Nurs. 
Clin. North Am. 10:3:587-597, Sep. 1975. 
2 Personal communication with Trudy Brown, 
Nursing Inservice Co-ordinator, Royal Ottawa 

1 Lief, Harold I. Sexuality - knowledge and 
attitudes, by... and Tyana Payne. Amer. J. Nurs. 
75:11 :2026-2029, Nov. 1975. 
2 Neubeck, Gerhard. Sex and awareness. In 
Ways of growth, edited by Herbert A. Otto and John 
Mann. New York, Grossman, 1968. 
3 MacRae, Isabel. Sexuality and irreversible 
health limitations, by ... and Gloria Henderson. Nurs. 
Clin. North Am. 10:3:587-597, Sep. 1975. 
4 Sedgwick, Rae. Myths in human sexuality. 
Nurs. Clin. North Am. 10:3:539-550, Sep. 1975. 
5 Smith, Jim. Sexuality and the severely 
disabled person, by... and Bonnie Bullough, Amer. J. 
Nurs. 75:12:2194-2197, Dec. 1975. 
6 Zalar, Marianne. Human sexuality; a 
component of total patient care. Nurs. Digest 
3:6:40-43, Nov.lDec. 1975. 

Elizabeth Finch (R.N., Toronto General 
HospItal; B.N., M.Sc.(Applied) McGill 
University) is the coordinator of nursing 
inservice education at the Royal Ottawa 
Hospital, Ottawa, Ontario. While attending the 
conference, "Sexuality and the Disabled," 
she was struck by the open and sincere 
sharing of feelings by the participants who 
earned "our undying respect, admiration. and 
gratefulness. Beverley Thomas, for example, 
who gave the opening address is without a 
doubt a remarkable, vibrantly alive woman." 
"It took an enormous amount of courage 
and 'sheer guts' for these people to share 
some of the most intimate and what for most of 
us would be devastating experiences in their 
lives. .. 
To those nurses who feel embarrassed 
discussing the topic of sexuality, Finch adds, 
"When you are overCome by these feelings, 
look at your patient who knows more about 
embarrassment, fear and vulnerability than 
most of us could ever imagine. .. 





a supportive approach 
to individuals in conflict 
with society. 

Jane Worden 

Three years ago, when I moved to the Forensic 
Unit of the institution where J work, the only 
thing I knew for sure about the patients there 
was that, at some point in their lives, they had 
all come into conflict with the law and had 
been subject to judicial process. Since then, J 
have cared for many of these patients and 
come to appreciate some of the problems 
involved in their rehabilitation. 
The need for nurses in this area of 
psychiatry is growmg as the need for mOre 
facilities for the assessment and treatment of 
these patients becomes increasingly obvious 
in our society. It is my hope that this personal 
account of my experiences and observations 
will spark a corresponding mterest among 
other nurses. 

The Forensic Inpatient Unit of the Clarke 
Institute of Psychiatry in Toronto can handle a 
maximum of 22 patients - 19 male patients. 
three females. Since most of these patients 
are remanded to our custody, the doors of the 
unit must be kept locked. The unit provides 
both assessment and treatment. Assessment 
is at the request of the courts, on behalf of the 
defence attorney, crown attorney or judge. 
Most patients are remanded for from 30 - 60 
days but staff may request an extension or ask 
to have the patient returned to custody before 
the designated time is up 
Assessments may be pre-trial- i.e. the 
person has been charged with an offence but 
not yet tried, or pre-sentence-- Le. the person 
has been convicted of an offence and an 
assessment requested, usually to aid the 
judge in dispensing an appropriate sentence 
to a suitable institution. 

Thirty to 60 days is obviously not a very 
long time in which to do a thorough 
assessment and therefore the staff must work 
quickly to discover all the relevant information. 
Along with routine blood and urine tests, an 
E.E.G. is usually done to rule out brain 
dysfunction that could have some bearing on 
the person committing the offence with which 
he is charged. Extensive psychological testing 
is carried out and detailed histories are taken 
by the doctor and added to information 
gathered by other staff involved with the 
Staff-patient contact varies from person to 
person and ranges from group therapy to 
one-to-one interactions with staff, but 
evaluation of the day-to-day social dealings 
with co-patients is probably our best tool for 
assessment. We see examples of many 
psychiatric illnesses, but most patients are 
labelled as having "personality"' or "character" 
disorders. In textbook terms, they are 
individuals whose behavior is amoral and 
anti-social, whose actions are impulsive, 
irresponsible, and serve immediate interest 
with little or no feeling of guilt or anxiety and 
without concerns for the legal or social 
consequences of their act. 
Each written report submitted to the court 
on the completion of an assessment is 
compiled by the doctors from information 
gathered by team members, including the 
nurses. social workers, psychologists, 
occupational therapists, and the doctor 
himself. The report contains information such 
as whether the person is fit to stand trial, based 
on whether he is certifiable under the Mental 
Health Act 1967, whether he understands the 
nature of the charges and the possible 
implications and consequences, whether at 
that point in time he is able to follow court 
proceedings and advise his lawyer. 


The Canadian Nurse January 1977 

appropriately, and whether he understands 
the meaning of the oath to be taken in court. 
A more personal assessment of the patient"s 
personality is also outlined and 
recommendations are made for treatment, either 
in a psychiatric facility or in an appropriate 
institution in the penal system. 
Along with assessments, the unit accepts 
some patients for psychiatric treatment. 
Re-admission of former patients for "crisis 
intervention" is not uncommon. Sometimes 
the court recommends that one of our patients 
who has had an assessment be retu med for 
treatment instead of incarceration. There is 
another group of patients who after serving 
some part of their sentence may be returned to 
the unit on a parole basis - Le., by serving the 
remainder of a sentence in close contact with 
an agency that provides rehabilitation to the 
community. Our rehabilitation program has 
extended to include patients now considered 
"sane" and released from the Hospital for the 
Criminally Insane in Penetangueshene, 
Ontario as ready to re-enter society. 

On the Job 
My nursing experience on the forensic 
unit began when I requested a transfer after 
several openings became available. The idea 
of working with "criminals" was intriguing and 
it was probably this curiosity that led me to 
The first two weeks went by as if in a 
dream. I recall sitting in the nurses' station 
reading charts and trying to fit the "charges" 
with the faces that occasionally appeared. 
That was, and still is, an impossible feat. 
I learned very quickly that each of these 
patients is an individual. Initially, most struck 
me as "nice guys," it was difficult for me to 
connect an individual with, for instance, a 
brutal rape, an armed robbery, or even 
murder. This tendency to stereotype and 
prejudge is one that I had to overcome; as very 
often it caused me to be less than objective in 
my approach to these patients. I came to the 
conclusion that I was doing myself and my 
patients an injustice. I soon realized that each 
patient has district needs peculiar only to him. 
The team approach helps to maintain this 
objectivity by a system of effective 
communication between members and by 
providing necessary feedback and even 
conflicting opinions. 
As we get to know our patients, problem 
areas begin to surface. Our unit is often their 
last contact with "society" before a long period 
of incarceration. Sometimes a patient is 
making a last attempt to get help after years, 
often a lifetime, of problems. For many 
patients, it is too late. They must face the legal 
consequences of their deeds, and their 

chances for rehabilitation in the prison system 
are slim. Often, patients have agreed to this 
assessment period merely to get a "good 
report," in the hope that the judge will allow 
them to go free on bailor to receive probation, 
a shorter sentence or even acquittal. They 
believe that if they are "good" and attend all 
the activities available they will receive a 
favorable report. They soon learn that this is 
not the case. 
After the staff has prepared the 
groundwork, the patient can either start 
working in groups and on a one-to-one basis 
with his staff, including at least two primary 
nurses, or he can sit back and openly admit to 
little or no motivation. We try to get the patient 
to make this decision himself but this is not 
easy for a person who has always avoided 
accepting responsibility for his actions. 
The therapeutic milieu we try to attain on 
our unit is based on trust '" a small word with 
enormous connotations. Some of these 
patients have never trusted anyone, much less 
a stranger, in the form of a nurse (who is after 
all, an authority figure). As staff, we are 
constantly tested with statements like - "You 
don't really care about me. This is just your_ 
job." We try to respond in an honest, 
straightforward and con.sistent manner. 
Openness and honesty on the patient"s part 
are also stressed. Using a give-and-take 
approach, sharing a little of ourselves and 
expecting the same in return, we try to 
establish a therapeutic relationship with each 
I share my expectations with him in the 
hope that he will begin to take the 
responsibility upon himself to set some 
realistic goals, and understand his personal 
limitations. Often he needs a great deal of 
guidance and support in these areas, but the 
nurse-patient relationship can be such that he 
will accept these from her. 
In working with the forensic-type patient, it 
is important to refrain from setting goals that 
are beyond his reach or imposing rigid, 
middle-class values. Instead, I try to set what I 
would consider easy goals so that positive 
gains are achieved and recognized by the 
patient relatively quickly, thereby helping him 
to acquire the self-confidence he so 
desperately needs. 
We must carefully examine the 
socio-economic background of each 
candidate for rehabilitation and then also 
consider how much of his life has been spent in 
institutions. We must be careful not to 
automatically assume that he can function in 
our society. Realizing this, I try to be sensitive 
to the needs of a patient to learn what I would 
consider an elementary task, like using a 
telephone or operating a vending machine. 
try to make the patient aware of this 
understanding early in our relationship. 

Good rapport, mutual understanding and 
trust make it possible for the patient to be less 
threatened in admitting his need to be taught 
and protect his pride and self-esteem from 
further damage. This supportive, 
non-threatening approach to teaching simple 
life-skills can be expanded into more 
complicated areas like interpersonal and 
social relationships. It is a slow and difficult 
process, but often it can lead to the roots of 
serious problems of depression, alcoholism or 
inadequacy that may, in turn, result in 
difficulties with the law. 
At first, I found it difficult to understand tl1e 
unconscious desire of some patients to return 
to jail. Usually these people have a history of 
repeated institutional admissions, ranging 
from orphanages to maximum security 
institutions. They have come to believe that 
prison will accept them and provide the 
security they so desperately need when 
society will not. In many cases, this is a fact. It 
is not unusual, for instance, to see one of our 
patients receive probation after assessment 
and return to us for rehabilitation. He begins to 
learn how to live a decent life, he finds a job 
and a place to live. He is discharged and seen 
on a regular out-patient basis. Then, suddenly, 
he is up on another charge, for no apparent 
reason. More often than not, he is just not 
ready to cope with the everyday hassles of life, 
and the institutional environment offers him a 
secure alternative to coping. Douglas was a 
patient like this ... 

Case History 
Name: Douglas H. 
Age: 25 
Birthplace: Smalltown, Manitoba 
Present Charge: Break and Enter, Two Counts. 

fhis patient was admitted for a 60 day assessment 
at the request of the trial judge prior to sentencing. 
Over the past ten years, he had been in jail many 
times on various charges. Invariably, he was under 
the influence of alcohol when he committed his 
oHences. Previous psychiatric contact was nil. 
Familial history revealed an alcoholic father and a 
mother who died when he was four years old. Doug 
spent four years in various homes in the community 
and then was adopted by a paternal uncle and his 
wife. While he was well provided for physically, his 
emotional needs were not adequately met, 
especially after the birth of a stepsister. 
Doug's real father introduced him to alcohol use 
when he was 12 years old. It would appear that in 
these formative years, he was confused and torn 
between identifying with his real father and his 
stepfather, as his adult model. He was still in close 
contact with his father and two brothers in the small 
community where they lived and alcohol was his way 
of relating to his "real family'" 
Doug was a shy, introverted teenager who used 
alcohol for courage and confidence in social 
situations. By 16, his dependency was 
uncontrollable and he needed money to support it. 
His first conviction was at age 15 and for the next ten 
years he progressed from county jails to the federal 
penitentiary. with only brief periods out on the street. 
While in prison he relates a considerable use of 
alcohol in the form of illegal "moonshine" made by 
the inmates, so his dependence was never really 
" interrupted through incarceration. 
When Doug arrived on our unit. he presented as 
a suspicious and quiet individual, unsure of the 
reasons for his admission and mistrustful of staff and 
patients alike. With a long history of incarceration 
this is not an unusual response: as nurses, we are 
confronted repeatedly with patients who question 
our motives in trying to establish a relationship, The 
self-esteem of these patients is often so low that they 
see no reason for our concern. 
Since Doug seemed unable to trust anyone, 
consistency of staff and a non-threatening approach 
were very important. He was encouraged to become 
involved in all the groups available including a 
closed insight-oriented group. Psychological testing 
revealed littfe pathology other than a tendency 
toward hypomania and impulsivity. A series of 
EEG's revealed some permanent organic 
dysfunction due to chronic use of alcohol. 
Nevertheless, he showed many resources, 
intellectual and emotional, that he could use if 
, motivated to do so. The prognosis remained 
guarded due to his long history of alcoholism. Doug 
himself admitted to a problem in this area though 
and expressed a desire for help with his problem. 
During his 60 days on the unit, Doug proved to 
be a warm, caring individual, with a capacity for 
insight, and the ability to form interpersonal 
lelationships with staff and patients. Team members 
felt that treatment could result in his eventual 
rehabilitation back Into the community and 
recommended probation. The judge concurred and 
Doug received a sentence of two years probation. 
Doug felt his drinking problem was the result of 
his background and it would appear that alcoholism 
was a 
ymptom of early deprivation, identity 
confusIon, low self-esteem and contact with a 
lifestyle condoning extensive use of alcohol, typical 
of the community where he grew up. His self-esteem 
improved remarkably as the result of feedback from 

patients and staff about the positive aspects of his 
personality. His general popularity on the ward 
resulted in his serving on patient committees and he 
became an appreciated as well as productive group 
member. The peer group support he received was 
important but the genuine caring that the staH 
demonstrated was probably more important 
because we were role models for him. Doug's 
motivation to change was very high. 
After sentencing, he was supposed to continue 
in group and individual therapy for approximately 
two months to facilitate further growth and improve 
his self confidence so that he could seek 
employment and live in the community. 
Treatment for Doug's alcoholism was 
discouraging. It was important that he transfer his 
dependency on alcohol to a healthy dependency on 
the unit, especially after discharge when he would 
need a great deal of support but this was not easy 
since he regarded any dependency, especially on 
women, as a weakness. Doug knew that continued 
alcohol abuse would mean more brain damage and 
possible return to prison. Intellectually he was able 
to say that he had to stop drinking. Emotionally, he 
had to discover for himself whether he could control 
his drinking rather than stop. On his first pass, he 
returned to the unit quite drunk. In this condition, he 
was angry, verbally abusive, aggressive and 
objectionable. His memory of this behavior was 
almost nil and when confronted with it, he was 
frightened enough to agree to begin treatment with 
Antabuse. This continued for about a month but he 
regarded this medication as a crutch and preferred 
to be independent. Since regaining his self-respect 
was extremely important to him the staH did not force 
the issue. 

Eventually, Doug returned to the community. 
Through employment counseling and much 
searching on his own, he found a good job and was 
we1I-liked by his fellow employees. Out-patient 
follow-up, in the form of supportive psychotherapy 
with two of the nurses who were his primary staff, 
was continued on a weekly basis for three months. 
Then, he was charged with assault following a 
drinking incident in a tavern. Because the charge 
involved a breach of probation, the judge sentenced 
him to the penitentiary. 
Should we regard Doug's treatment as a 
fanure? Where did we go wrong? Did we waste a lot 
time and energy on a hopeless case? I would have to 
answer "NO" to all of these questions. I feel that 
Doug benefited immensely from our program. I think 
that loneliness and situational depression, leading to 
an increasing use of alcohol again after discharge 
were the cause of his "downfall'" He admitted that 
drinking was his only wav to socialize. Apparently his 
ability to be independent was '.mited and I feel this 
was due more to hIs '0"9 . istc')' Of 
ion than to any failure on our part. 
Although Doug ended up back in prison, I feel 
sure he will maintain the gains he made and be able 
to use these once he is released again. He definitely 
learned a great deal by his mistakes and he was 
certainly aware that he had to take responsibility for 
his own actions As nurses, we cannot feel 
responsible for this so-called failure and, as a team, 
we can use cases like Doug's and countless others 
to learn from and discover new and different ways 
of dealing with future patients. 

Invariably, we spend many, many hours 
working with "antisocial behavior" problem 
patients before we see even a small amount of 
progress. I try to maintain a degree of 
perspective with each individual patient. I have 
learned to cope with temporary defeat and 
discouragement. Eventually, a substantial 
number of our patients do make it. There may 
be crisis-intervention admissions or another 
prison term intervening, but often this is just 
part of the learning process. What seems like a 
tiny step forward to us, is often really a giant 
step for the patient and the trial and error 
process really does work in the long run. 
At first, many of our patients appear to be 
beyond our help. I am amazed, however, when 
I think of the number of them that we have 
almost given up on who suddenly do a 
complete about-face and begin to work 
themselves on their problems. 
In this job, I am constantly learning new 
techniques, new theories, new approaches. I 
have made some mistakes but I have also 
learned to periodically reassess myoid values 
and adapt some of them to meet the needs of 
the patients and the unit. In short, my work with 
forensic patients has been a rewarding 
experience; through it, I have aChieved personal 
growth beyond my original expectations. .. 


Jane Worden, R.N., author of Caring for the 
Forensic Patient, worked on the Forensic Unit 
of the Clarke Institute of Psychiatry in Toronto 
for almost four years before writing this article. 
She points out that her observations are 
based entirely on personal opinions and her 
experience on the Unit, developed in 
consultation with co-workers. A graduate of 
Peterborough HospItal School of Nursing, 
Peterborough, Ontario, Worden joined the staff 
of the Clarke Institute in 1971. After 15 months on 
the Child and Adolescent Unit, she transferred 
to the Forensic Unit where she remained until 
She is now working as a home care worker 
with the East Metro Children and Youth Services 
Department of the City of Toronto. In this position 
she says she deals with "potentially 
forensic-type patIents, .. treating the entire family 
along with the child. 


The CanadIan Nurse January 1977 

The Nurse Continuum Perspective 




"\ r'"-\ 









Author's preface: 
This personal expression of attitudes and opinion is 
not meant in any way to indicate issues of nursing 
education, nor to reflect on the quality of nursing 
care in any specific area the 26 years that I 
have been involved, either directly or indirectly, with 
nurses, many of my friends and associates in both 
Canada and the United States have voiced their 
concern over the status of nursing. This article is the 
result of their comments, as well as my own 
personal experiences in the area of nurse-nurse 
I note, also, the contribution of Dr. W. B. W. 
Martin, Department of Sociology, University of New 
Brunswick. Dr. Martin, who is the author of The 
Negotiated Order of the School (MacMillan 
Company of Canada Umited 1976) delivered the 
series of lectures on small groups that helped to 
pinpoint the interpretation of nurse-nurse 
associations described below. 
Hopefully, readers of The Canadian Nurse will 
recognize that this perspective is not stereotyping, 
for the notion of a continuum suggests that there is 
constant opportunity for change. It is never too late 
to alter our behavior patterns. That is the whole 
meaning behind the Nurse Continuum Perspective. 



l .".\.,. (..... 
1\ ..,. 
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.. - 






I his article is unique in the fact that it is not 
-.. based on past studies; it does not include 
statistics or references, nor does it have a 
bibliography. It is, quite simply, a description 
of one nurse's ideas about the interaction 
between members of the nursing profession 
at this particular point in time. 


It is the author's contention that it is not 
systems, governments or other disciplines that 
are the greatest barriers to the progress of 
nurses in the field of health care. The initial and 
most common barriers are, in fact, other 
nurses. Negative nurse-nurse interactions 
can be, and often are, a definite deterrent to 
change. Until this fact is accepted and dealt 
with appropriately nurses may continue 
forever on a weary continuum of stress. 

Listening, sharing, encouraging 
and understanding are too often 
missing from nurse-nurse 

We can accept the fact that nurses are 
persons who should care about other people. 
What we cannot seem to accept is the fact that 
nurses should also specifically care about 
other nurses. In our rush to reach a desired 
personal or professional level - in the 
constant struggle to cope with nursing 
problems - we frequently overlook the 
importance of the human qualities that are vital 
to the survival of good working relationships. 
Listening, sharing, encouraging and 

understanding are too often missing from 
nurse-nurse relationships. This failure to find a 
common ground and establish lines of 
communication stifles and inhibits efforts to 
negotiate and compromise. In the end, talks 
break down, impetus is lost and change 
becomes impossible. 
In an attempt to open the lines of 
communication between nurses and to create 
greater understanding, the author has devised 
a simple but dynamic tool that offers some 
handy landmarks in recognizing the difficulties 
inherent in nurse-nurse relationships. The 
Nurse Continuum Perspective proposes three 
broad groupings of attitudes with varying 
degrees of compliance measured along a 
sliding scale between the two extremes. At 
one end of this continuum is the 
"Institutionalized Nurse" - who gives every 
indication of being a rigid, non-flexible, 
immovable object. Her position in the health 
care field seems relatively stable largely 
because, although she is verbally active, in 
actuality she strongly resists change. The 
contribution to nursing that the 
Institutionalized Nurse is capable of making is 
limited and almost never fully realized. 
She feels secure and comfortable only with 
well-established habits and routines; change 
represents a threat. In reacting to new 
situations, she often attempts to inflict her 
present notions and unchanging values upon 
other nurses. 

The Institutionalized Nurse feels 
secure and comfortable only with 
well-established habits and 

Examples of the Institutionalized Nurse 
are familiar to all of us. A classic one is the 
nurse who stifles the creativity of other nurses 
with her deference to authority or constant 
compulsion to rigidly adhere to unimaginative 
procedure and maintain the status quo. 
At the other end of the continuum is the 
"Polemic Nurse" who has rejected the 
bureaucratic system and constantly creates 
turmoil and stress by means of negative 
feedback. She seems incapable of making 

The Institutionalized Nurse 


Hinders Change 
Stifles Creativity 

Status quo 

The Nurse Continuum Perspective 

The Kinetic Nurse 


Progress for Nurses 


The Polemic Nurse! 

Gives Negative Feedback 
Causes Stress 

State of Constant Confusion 

constructive criticism and is noted for being 
picky over trivia - particularly while others are 
attempting to concentrate on the real issues of 
patient care. The Polemic Nurse presents a 
hazard to those around her because of the 
discouragement she causes among her 
associates. Polemic Nurses smother 
enthusiasm with their negative and hostile 
attitude and, unfortunately, co-workers who 
are exposed to this are inclined to give up in 


The Polemic Nurse subjects her 
co-workers to an unending stream 
of carping criticism directed 
against "the system" or the peopl 
she orks with. 

It seems strange that an occupational 
group that utilizes the concept of rewards to 
shape behavior, somehow overlooks the use 
of pos;tive reinforcement in the patterning of 
behavior in other nurses. (After all, other 
people besides Brownies like Brownie points!) 
Negative feedback discourages and 
depresses its recipients and both 
Institutionalized and Polemic Nurses seem to 
display a definite skill in this area. 
Somewhere in the center of the 
Continuum is the Kinetic Nurse. She is the 
individual who continually tries to handle 
day-to-day situations in a creative and 
growth-producing manner; ultimately she is 
responsible for most of the improvements and 
advancements within her profession. Kinetic 
Nurses are pulled back and forth on the 
Continuum according to the frequency of their 
encounters and involvement with their 
Institutionalized and Polemic colleagues. This 
back and forth movement depends upon how 
skilled the Kinetic Nurse is in devising 
strategies and tactics for coping with these 
other two kinds of nurses. The maneuvers she 
is forced into often cause loss of valuable 
'emotional' time and may cause the Kinetic 
Nurse to adopt some of the negative 
characteristics of the other two groups. 
Periodically, many nurses feel compelled 
to "play the game" in order to obtain 
professional advancement or even survive. 

Kinetic student nurses may be confronted by 
an Institutionalized instructor. They recognize 
the passive role they may have to adopt to 
receive a favorable evaluation and they 
suppress their creative techniques 
"Playing the game' may also occur in other 
work situ ations. The Kinetic Nurse often finds it 
necessary to strive for approval of the 
Institutionalized and/or Polemic Nurse but, at 
the same time, has difficulty in maintaining the 
acceptance of her nursing peers. There is 
constant dissonance in this type of working 
situation and little opportunity for progress. 
Both Institutionalized and Polemic 
Nurses, if they obtain supervisory positions, 
are often guilty of inhibiting Kinetic Nurses 
from expressing their true feelings. When this 
occurs, the profession is prevented from 
establishing better understanding among its 

The "I Win - You Lose" attitude 0 
many nurses defeats progress 
within the profession. 

members and with other disciplines. All nurses 
must feel free to share their honest concerns 
within their own professional group. 
As a result of the polarizing effect of the 
Nurse Continuum Perspective, all three 
groups of nurses tend to adopt an "I win -you 
lose" attitude towards their fellow workers. In 
this kind of nurse-nurse relationship there can 
be no opportunity for compromise. Nursing 
issues remain unchanged and problems 
remain unsolved. Nurses cannot afford to be 
static; they must be dynamic and since 
Institutionalized and Polemic Nurses 
encourage stagnation and apathy, progress 
depends on the efforts of the Kinetic Nurse. 
Readers will recognize that one 
inadequacy of the Nurse Continuum 
Perspective is the emphasis it places on the 
negative aspects of nurse-nurse interactions 
Positive aspects do exist: how else could 
nursing have moved forward to its present 
position in the field of health care? 
The Nurse Continuum Perspective is 
meant to present more than a philosophic 
viewpoint; it also has a pragmatic value. It 

applies to all nurse-nurse interaction and all 
areas of nursing. It gives each of us the chance 
to honestly rate our own position on the scale 
and, eventu ally, to assess one another's fau Its 
and merits in an objective and constructive 
Nurses at all levels must develop the 
capacity to understand each other; they must 
make a concerted effort to work things out 
through compromise. They must encourage 
and support one another. A great deal remains 
to be accomplished in nursing but none of this 
will be realized if we fragment our resources 
and dilute our strengths. 
"All things must change and we must 
change with them." If Kinetic Nurses can 
confront and negotiate with the initial barriers, 
(Polemic and Institutionalized Nurses) and at 
the same time succeed in obtaining the 
cooperation of these nurses in working 
together for the common good, then ideas can 
be shared and individual efforts encouraged. 
With these kinds of nurse-nurse relationships, 
progress in nursing will be measured in leaps 
and bounds." 

Arlee D. McGee, R.N., B.N., describes the 
Nurse Continuum Perspective, as "simply a 
means of providing food for thought in this 
area." She observes that, although a great 
deal has been written and talked about 
concerning nurse-patient interaction and also 
the doctor-nurse game, articles about 
nurse-nurse relationships are conspicuous by 
their rarity- even though this is a very 
significant area. 
McGee recently completed her post 
basic nursing degree at University of New 
Brunswick School of Nursing in Fredericton 
after an absence from the classroom that 
lasted over two decades. She is a graduate of 
Victoria Public Hospital School of Nursing in 
Fredericton and received a diploma in 
psychiatric nursing from the University of 
Western Ontario in London. 
She was instrumental some time ago in 
starting a Home Visiting Teaching Program for 
developmentally handicapped children in 
York County, N.B., and this year she designed 
and taught a course for attendants working in 
alcoholism detoxification centers. 


A new tradition of professional responsiveness. 
A new commitment to expanded medical seNices through increased 
product development, brooder medical communications, greater patient 
information, enhanced pacl",aging. 
Our new tradition will be bacl",ed by the some commitment, vigor and 
intensity that introduced insulin to the world. That put Connaught in the fore- 
front of biological research. 
And the new tradition, together with our ongoi ng dedication to research, 
is still another way in which we can continue to contribute to the health core 
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For any professional or medical information please call oUf Customer 
Servlc Deportment (416) 9 or th Medical Director (416) 66 -2622. 
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The Canadian Nurse January 1977 

A New Role for Nurses 


For the past two and a h9.lf years, nurses at the 
Toronto General Hospital have been involved 
in the education and counselling of therapeutic 
abortion patients within the 
gynecological/obstetrical service. It really 
began in 1972, when Nancy Snelgrove, a staff 
nurse in gynecology at T.G.H., recognized the 
need for counselling and support of 
therapeutic abortion patients. Up until that 
time, very little contraceptive counselling had 
been offered to them. 
With the support of the nursing 
department at T.G.H., Nancy Snelgrove 
developed a program that involved visiting all 
abortion patients pre- and post-operatively. 
During these visits, she spent time discussing 
contraception with patients according to their 
needs, dividing her eight-hour shift between a 
regular patient assignment and the 
counselling of abortion patients. Gradually, 
she expanded her counselling role, and 
became the nurse-counsellor for all women 
admitted for therapeutic abortions. 



It is very easy, and erroneous to view the Issue of 
abortion in simplistic general terms. The problem.of 
unwanted pregnancies is multilayered; approaches 
to it are feeble, haphazard, and lacking in 
understanding. Inconsistent media and 
medical information, sexual politics, 
women's sexual needs and random, 
one-dimensional family-lIe 
education classes are only a 
few of the factors 

We have been subjected to 
intense, rigidly defined sex-rc/es and 
unrealistic expectations for both men 
and women. Our attitudes are a 
culmination of many years of covert 
and overt sexual conditioning. 

. Bonnie Easterbrook (R.N.) is a 
graduate of the Toronto General 
Hospital School of Nursing in 
Toronto. She has worked as a 
counsellor with Planned Parenthood 
in Toronto and San Francisco, and 
was a team leader for a 
Community Outreach project 
through Planned Parenthood of 
Toronto in 1972. In 1973, 
Easterbrook helped to organize a 
teen conference 'Sex Seminar A toZ' 
for Planned Parenthood of Toronto. 
In 1974 she was an R.N.A.O. 
delegate to the Ontario Conference 
sponsored by the Family Planning 
Division of Health and Welfare 
. Beth Rust, (R.N.), the author's 
co-worker on the counselling team, 
is a graduate of Wellesley School of 
Nursing, Toronto. She is a past 
board-member and volunteer 
counsellor for A.G.C.R.A., and 
Planned Parenthood of Toronto and 
has had 5 years training and 
experience in family-life counselling 
with the Toronto Institute of Human 
Relations. Rust was also a 
participant in a summer program at 
the Institute for Sex Research at the 
University of Indiana. 

Two registered nurses now share in the 
counselling of patients admitted to T.G.H. for 
therapeutic abortions. Beth and myself both 
work in this capacity for four hours a day, an 
arrangement found beneficial to us because of 
the intensity inherent in abortion counselling, 
because of the necessary repetition 
f basic 
information, and because of the importance of 
a fresh and enthusiastic approach to individual 
patient's problems and anxieties each day. We 
work individually, although we have close 
contact with each other in our work. 
Beth and I visit all women admitted to 
T.G.H. on an in-patient basis for either suction 
D & C or second trimester saline injection. 
Most women prefer to have a D & C under 
general anesthesia, while a small number 
have the procedure done in the out-patient unit 
with the help of a local anesthetic. (The 
out-patient unit is separate from our ward.) 
The doctor determines which procedure is 
most suitable for the patient. 
Our initial visit with the patient occurs on 
her admission to the nursing unit. At this time, 
we explain how the abortion will be done. We 
encourage the patient to express her fears so 
that we can help to clear up any mistaken 
ideas she may have about the procedure. We 
also invite questions from the patient and her 
partner or parents. 
It is Our experience that most patients 
have not been informed about what is going to 


happen to them, particularly if they have been 
referred to our service by a private physician. 

We live in a society tha: sexual;zes 
everything from shoelaces to 
toothpasta. On the one hand, it is a 
society whose media urge women to be 
sexy: paradoxically, it is a society tha
doesn't accept sexuality as a normal 
healthy part of whole human beings. 
Our sexual conditioning is, to say the 
least, confusing. 

Their apprehension about the abortion itself is 
often compounded by the fact that they feet 
little regard has been paid to their emotional 
state at a time of intense personal crisis. 
During this visit, Beth and I attempt to find out If 
the woman has any support from her family, 
husband or boyfriend, so that we can help her 
to work out her feelings about their reactions to 
her decision. Quite often the fact of an 
unwanted pregnancy, or the decision to have 
an abortion forces the patient to question her 
perceptions of the relationship she has had 
with her partner. She may find herself alone at 
a time when most in need of acceptance and 

Women are asking for good 
alternatIves to the birth control pill for 
contraceptive purposes. The pill 
cannot cover the span of a woman's 
reproductive years. The combination 
of birth control foam and the condom 
is one extremely effective method for 
preventing pregnancy bolt requires :he 
man's cooperation as well. 

In preparing the patient for the procedure 
Ip.volved in the abortion, we tell her about the 
use of the laminaria tent. This device is used at 
T.G.H. to cause slow dilation ofthe cervical os 
in order to minimize cervical tissue tear and 
shorten the time necessary for general 
anesthesia in the operating room. The 
laminaria tent is inserted by a doctor on the 
evening before the abortion to begin dilation of 
the cervix. Occasionally, menstrual-like 
cramps occur. The tent is made of 
compressed seaweed, and resembles a small 
stick when it is inserted in the cervix. It is 
removed prior to the suction D & C. 
Often when procedures and the rationale 
behind them are explained fully, the patient 
can relax within the hospital setting with less of 
the 'unknown' to fear. This may be the firsttime 
the patient has any feeling of acceptance and 
support for her decision. When the patient's or 
couple's questions have been answered, we 
tell her that we will see her after the abortion 

and on the morning of her discharge from the 
Patients admitted for suction D & C come 
into the hospital on the afternoon or evening 
prior to the abortion. They have the abortion on 
the following day, and are not discharged until 
the morning of the third day, when we have a 
group discussion. 
Our group meeting entails the discussion 
of after-care instructions, birth control 
methods, self-examination and the dynamics 
of male-female relationships. Prior to the 
group meeting our emphasis is on supporting 
the patient and establishing a trusting 
relationship with her. We consider this to be of 
importance because women admitted for 
abortions are often defensive and suspicious 
when they reach the hospital door - far too 
often they have been subjected to the 
dogmatic posturings of doctors, clergy and 
friends regarding their decision to have an 

The onus has always bean on 
women to assume responsibility for 
birth control. But women must not be 
confused about their sexuality; they 
must understand enough about 
themselves to be able to assert 
themselves and demand responsibility 
from their male partners. 

Beth and I are also involved in counselling 
women admitted for second trimester 
abortions by intra-amniotic saline injection. 
This method is used for women who are at 
least 17 weeks pregnant, and requires that the 
patient remain in hospital for four to five days. 
As the patient having a saline injection is in the 
hospital tor a longer period of time, we have 
more time to help her to work out her feelings 
about her decision. And this extra time is often 
Many ofthe women admitted for a second 
trimester abortion have had great difficulty in 
reaching a decision about what to do. The 
reason that a woman's actions are delayed 
may often be attributed to the fact that she has 
weighed her decision with painstaking care to 

We hear so much adverse publicity 
about the pill, and hesitate to use it. It is 
difficult to feel secure when five 
doctors give five different answers to 
our questions about side effects. 

choose the best of alternatives available to 
her. Some women have abortions at this stage 
of their pregnancy due to delays and 
misassessment by the doctor. Most of the 






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, , 
.... -..

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Author Bonnie Easterbrook (standing) and 
her co-worker. Beth Rust in their office at the 
Toronto General Hospital. 

patients admitted for second trimester saline 
injections have in fact sought medical help 
immediately after they missed their second 
penod. The patient may feel hostile towards 
her partner and/or men in general, a situation 
aggravated if her partner has abandoned her. 
Beth and I wear street clothes during our 
working hours, a fact that helps many women 
feel more comfortable in talking to us. Very few 
women refuse to participate in our group 
discussions. There are however, exceptions. 
Often an older woman will prefer a one-ta-one 
discussion with Beth or myself, feeling very 
strongly that she 'should have known better.' 
Other women may feel intimidated by groups 
- the patient and partner may feel much freer 
to discuss contraception when they are alone 
with us. Our program is flexible enough for 
improvisation and in such circumstances, we 
talk together in the privacy of the patient's 
Most patients are pleasantly surprised by 
the group support that evolves during the 
meeting. Our patients are usually between the 
ages of 17 and 26, of varied ethnic 
backgrounds and religious persuasions. The 
group decides what direction their discussion 
will take while Beth and I act as resource 
persons. In the meetings, we discuss a whole 
gamut of topics related to women's health 
issues. We cover simple female anatomy and 
physiology, after-care instructions to fo/lowthe 
abortion, birth control methods and their 
efficacy rates. 


The Canadian Nuraa January 1977 

After-Care Instructions for Patients Having Therapeutic Abortions. 

1. Bleeding similar to menstruation will continue for seven 
days or less; watch ifthis bleeding is heavier and followed by 
severe cramps, backache and nausea 

2. Take your temperature for five to seven days, and if it is 
elevated for 24-48 hours and associated with the above 
symptoms, contact your family physician or come to the 
Emergency Department. 
. Do not take tub baths until bleeding stops; showers and 
sponge baths are permitted. Do not douche or go swimmmg 
until bleeding stops. 
. Do not use tampons until your next period - use sanitary 
. Do not have interCiourse until you have stopped bleeding 
- preferably wait until you have had one normal period. 

3 Strenuous exercIse should be avoided for at least one 
week as It may cause further bleeding. 




4. If your doctor has prescflbed medIcation to prevent 
bleedmg expect a few cramps and clots. 

5. Due to hormonal changes. some women will experience 
depressIOn or their breasts may be 60re and perhaps leak. 
Wear a supportmg bra and reduce fluid intake. Most 
Important, realize it is a normal response and it will pass. 

6. If you are going to take birth control pills, please begin 
taking them the first day YOú get home, according to 
directions in the instruction booklet. 

7. In about one month's time, return to your doctor or to our 
clmic for a checkup. 

8. If you have any problems within the next few weeks and 
want to talk them over, please phone us. (11:00 a.m. is a good 
tIme for phonrng). Leave a message if you cannot contact us 
and we will call back. 


All CanadIan nurses nursing students and 
members of theIr famIlies are invIted t" 
particIpate In a unIque tour I" the ICN 
Congres_ and beyond 



'Of the exclt.ment of the ICN Congress 
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'Of tropiC sun and r.18xllllon 


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modatIons - TOKYO 6 n"Jhts HONG KONG 
4 nIghts. HONOLULU 3 nI'lhls. Ame. ;;an 
breakfast dall
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and hotel . shuttlp bus 
 between ICN 
Congres HOtE nentatlLn tour In each ( 
WI' ome recel lInin Hong K( J II. II 
gr -t,ng in Hon lulu Spe -.,al farr .ve" 
Hawa"an banquet 
May 27. June 10. 1977 
, -n Vancouver $995' 
Spec'allow add.ons Ir0m otl1e' CanadIan 
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Th un est ft rsponson 



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Part of our discussion deals with female 
sexuality - our goal here is to demystify the 
topic and help women to feel comfortable with 
themselves and their bodies. This discussion 
continually reveals to Beth and I just how 
frightened women are to be open and 
accepting of their bodies. We deal with the 
topic in a frank and open manner - we talk 
about self-examination of the genitals, the 
vagina, the clitoris and its responsivity. Often 
this discussion represents the first time 
approval and encouragement has been given 
to self-examination. We emphasize the 
importance of honest, gutsy communication 
between couples regarding sexual feelings, 
and the responsibility of both partners for birth 
control. In this couple of hours, we hope to 
stimulate an expression of opinions and 
questions, and the beginnings of awareness. 
The groups themselves provide positive 
feedback to our efforts - patients often relate 
their appreciation of our counselhng and 
support to their doctors, who in turn tell us 
about it. 
Beth and I make every effort to talk to 
interns and residents on the gYò1/obs service 
about our counselling program to help create 
some awareness and understanding of the 
problems women confront when they have an 
abortion. We also contribute to the staff 
development program for our own gyn/obs 
departmental staff nurses. ... 

We are entitled to learn and 
discover our sexual selves throughout 
our lifetimes. Our sexuality must be 
given positive value by our society. 

Boston Women s Health Book Collective Our 
bodies. ourselves Rev 2ed New York, Simon & 
SChuster, 1976. 
Recommended reading: Watters, Wendell W. 
Compulsory parenthood: the truth about abortion 
Toronto McClelland & Stewart, 1976 

Keeping up-to-date with new techniques and new ideas in her profession requires that the nurse 
continue to learn long after she has left school. Staff development progra'11s provide an opportunity 
to do this in a structured, formal way within the hospital setting But formal learning programs can be 
made more effective by using some of the techniques that adults use to learn on their own every day. 

The Tip of the Iceberg: 

Staff development and the universe of adult education 

JackIe Barber One of the thorniest problems confronting 
staff and administrators at individual hospItals 
today is the issue of inservice education. How 
much? how? for whom? are questions that 
administrators face in organizing staff 
development programs. and they may feel 
their problems are compounded by the 
ambivalent reactions they get from nurses. 
Many staff nurses feel that their 
professionalism is dependent on keeping up 
with advances in medical technology, 
learning new techniques and expanding their 
awareness, and are eager to participate in 
any learning experiences that are available. 
Other nurses seem to be completely 
uninterested in going to any more classes 
once they have finished school. The attitudes 
of head nurses toward staff development, 
whether they are willing to make work 
schedules flexible enough to encourage 
particIpation and what provision they make for 
nurses to use and share new knowledge with 
others. also determine the success of 
inservice education programs. 
Hospital educators are faced with these 
and many other considerations In their 
attempts to plan successful education 
programs. To make the learning experience 
more valuable to individual nurses that 
participate, and thus to the hospital that gives 
them, it is helpful to look at some general 
principles of adult education 

.t:\ The Magnitude of Adult Education 

 When adults learn, they do so in a variety 
of formal and informal ways. Formal education 
takes place in a classroom, lecture hall or 
conference room. It is directed by a teacher, 
lecturer, group leader or resource person. 
Formal education can be quantified. You can 
count the number of people who attend class, 
the number of hours spent in the classroom 
and the number of right and wrong answers on 
the final examination. 
Many books have been written about 
formal adult education, a"d about how to 
ensure that maximum leamil"g takes place in é!. 
formal setting Perhaps one ofthe most helpful 
of these books is The Modern PractIce of 
Adult Education, 1 by Malcolm Knowles. 
There is no denying that much valuable 
learning can take place In a well-structured 
formal setting, but most adult learning takes 
place informally. Allen Tough, in his book The 
Adult's Learning Projects. 2 proves 
conclusively what we all have suspected, that 
adults learn a great deal on their own, with a 
little help from their friends and the local 
librarian. It is a fascinating book and of great 
importance to adult educators. 
The universe of adult education can be 
likened to an iceberg. The tip is what we see- 
the workshops. conferences, lectures, 
seminars, courses - but below the waterline 
is where the majority of adult education really 
takes place. 
Hospital educators are like solitary 
fishermen, saili'lg the North Atlantic in small, 
fragile boats. Worrying about the tip of the 
iceberg is formidable enough without 
concerning themselves with what lies below 
the waterline. And yet, many facets of the 
unseen part of the education iceberg can be 
used to increase the quality. quantity and ease 
of formal hospital education. The books 
mentioned above, by Knowles and Tough, 
give some very practical guidelines. 





'r ou rY1 WI to take advantage of LIPPINCOTT'S GUARANTEE OF SA TISF ACTION. 
We will gladl) send you any book on 15-day approval. Upon subsequent t^dmination of the 
book, if you are not completely satisfied, you may return the book to us without obligation. 
Also. yot. can save delivery charges b
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Altemeier, Burke, Pruitt and Sandusky 
Provides up-to-date information for the control in hospital 
Lippincott 280 Pages Illustrated 1976 $16.00 

Bates, Hoekelman, and Wabnitz 
A cornerstone- for any teaching program in primary health 
Lippincott 375 Pages Illustrated 1974 $18.75 

NURSING, 3rd Edition 
Brunner and Suddarth 
This leading text is outstanding in its depth of scientific 
content and in the practicality of its application. 
Lippincott 1156 Pages Illustrated 1975 $19.75 


The most useful nursing book ever! 
Brunner and Suddarth 
This now famous ready reference puts virtually all of nursing 
right at your fingertips! 
Lippincott 1473 Pages Illustrated 1974 $21.50 

Includes technological advances in intravenous equipment 
and techniques, and the latest findings on asepsis and hazards 
of contamination. 
Little, Brown 348 Pages 
Paper, $6.95 

III ustra ted 
Cloth, $10.95 


Surgical Nursing, 4th Edition 
Smith and Germain 

Hoole, Greenberg and Pickard, Jr. 
This is the ideal pocket reference for all professionals engaged 
in the delivery of primary health care. 
Little, Brown 339 Pages 1976 $7.95 

Provides an authoritative basis for understanding the patient's 
therapeutic regimen, including surgery, drugs, nursing inter- 
vention and rehabilitation. 
Lippincott 1229 Pages 
Paper. $16.95 

Cloth, $21.75 


and Physicians 
This manual of clinical guidelines fits conveniently into the 
pocket of a lab coat. 
Lippincott 461 Pages 1976 $8.75 

THE DYING PATIENT: A Supportive Approach 
Written specifically for the many hundreds of thousands of 
practicing nurses who care for the critically ill and dying 
patients, this sympathetic and practical book offers compas- 
sionate solutions to the difficult problems they encounter. 
Little, Brown 228 Pages 1976 $6.95 

Department of Nursing Massachusetts General Hospital 
Little, Brown 389 Pages Illustrated 1975 $8.95 

Practical ECG Interpretations 
Mangiola and Ritota 
Provides clear and authoritative information for the inter- 
pretation of cardiac arrhythmias. 
Lippincott 215 Pages Illustrated 1974 $22.00 

To order any of these outstanding books simply return the 

A Basic Guide 
Ie Farland 
\ beginning text that assumes no prior knowledge of cardiac 
rrhythmias, this book pro\ides a systematic method of 

A Maternal -Newborn Text 
Provides prospective and practicing nurses with the most 
authoritative up-to-date information available on maternal 



No POStage stamp necessary If maIled In Canada 
Postage will be paid by 

M8Z 4X7 

I and emotional 
Is, and provides 
ternity nursing. 
976 $14.75 

th Edition 

10 ad olescence, 
growlh, deveJ- 

976 $17.95 


ving good staff- 


patient and implement a plan of nursing management. 
Lippincott 488 Pages Illustrated 1975 $15.75 

Paper, 55.95 

Cloth, $ 11.50 

Berk, Sampliner, Artzer and Vinocur 
Outlines in step-by-step detail Ihe diagnostic methods and the 
specific therapy necessary to treat critically ill patients effec- 
tively and efficienl'}. 
Little, Brown 574 Pages Illustrated 1976 $12.50 

Skydell and Crowder 
Clear directions on what to tell patients to expect, rn order 
to spare them unnecessary anxietv. 
Little, Brown 248 Pages 1976 $6.95 

Bringing together the e>o:pertise of 29 specialists in all aspects 
of acute care, Ihe expanded edition of this well-known 
manual is a musl for all professional personnel working 
on the emergency-room team. 
Little, Brown 459 Pages Illustrated 1976 
Paper, $12.50 Cloth,517.50 
2nd Edition 
Roaf and Hodkinson 
"This is a book to be included in the library of all schools of 
nursing, whère its clearly written text and wonderful sel- 
ection of illustrations will make the learning or orthopaedics 
so very much easier and mor enjoyable." 
-Nursing Mirror 
Blackwell 592 Pages Illustrated 1975 518.50 

APPROACHES: Patient Care and Document<:tion 
Walter, Pardee and Molbo with 16 Contributors. 
Challenges the nurse to explore the development of the 
problem-oriented approach in a clinical situation. 
Lippincott 206 Pages 1976 $6.75 




Representing in Canada: 
J. B. Lippincott Company 
Blackwell Scientific Publications 
Liltle, Brown and Company 
Springer Publishing Company, Ine. 

aid order card with your selections marked. 

Servmg the Health Profession in Canada Since 1897 
75 Horner Aye., Toronto, Ontario 1\t8Z 4X7 



You r'" WI 
We will gladl 
book, if you 
AI"u, au ca 
privilege is gl 



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 I- I- Q.. U 
 <( ctO U I- U.= I- U I- J: UJ I- Z 


Altemeier, Burke, Pruit 
Provides up-to-date infor, 
Lippincott 280 Pages 

NURSING, 3rd Edit 
Brunner and Suddarth 
This leading text is outstan 'lng In Its Lepth of sCientifIC 
content and in the practicality of its application. 
Lippincott 1156 Pages Illustrated 1975 $19.75 













"0 -S 
o s 
-;j W ...... 
c C u 
: 0 .%!., 
c en o.c 
., en -'
;'wW c(




and techniques, and the latest findings on asepsis and hazards 
of contamination. 
Little, Brown 348 Pages 
Paper, $6.95 

The most useful nursing book ever! 
Brunner and Suddarth 
This now famous ready reference puts virtually all of nursing 
right at your fingertips! 
Lippincott 1473 Pages Illustrated 1974 521.50 

Cloth, $10.95 


Surgical Nursing, 4th Edition 
Smith and Germain 

Provides an authoritative basis for understanding the patient's 
therapeutic regimen, including surgery, drugs, nursing inter- 
vention and rehabilitation. 
Lippincott 1229 Pages 
Paper, $16.95 

Hoole, Greenberg and Pickard, Jr. 
This is the ideal pocket reference for all professionals engaged 
in the delivery of primary health care. 
Little, Brown 339 Pages 1976 $7.95 

III ustra ted 
Cloth, $21.75 


THE DYING PATIENT: A Supportive Approach 
Written specifically for the many hundreds of thousands of 
practicing nurses who care for the critically ill and dying 
patients, this sympathetic and practical book offers compas- 
sionate solutions to the difficult problems they encounter. 
Little, Brown 228 Pages 1976 $6.95 

and Physicians 
This manual of clinical guidelines fits conveniently into the 
pocket of a lab coat. 
Lippincott 461 Pages 1976 $8.75 

Practical ECG Interpretations 
Mangiola and Ritota 
Provides clear and authoritative information for the inter- 
pretation of cardiac arrhythmias. 
Lippincott 215 Pages Illustrated 1974 $22.00 

Department of Nursing Massachusetts General HospItal 
Little, Brown 389 Pages Illustrated 1975 $8.95 

To order any of these outstanding books simply return the 


A Basic Guide 
Ie Farland 
\ beginning text that assumes no prior knowledge of cardiac 
rrhythmias, this book provides a syslematic method of 

arning to evaluate an ECG strip_ 
ipringer 128 Pages 1975 $5.25 
IVritten primarify for the CCU nurse in the community 
lospital, where lack of elaborate monitoring apparatus means 
he nurse must rely on clinical skill and judgement for 
etecting critical changes in the patient's condition. 
pringer 465 Pages Illustrated 1976 $13.95 

A Maternal -Newborn Text 
Provides prospective and practicing nurses with the most 
authoritative up-to-date informal ion available on maternal 
and child care. 
Little, Brown 445 Pages Illustrated 1976 $15.00 

\1ATERNITY NURSING, 13th Edition 
Integrates nursing assessment of both physical and emotional 
factors, applies evaluation and diagnostic skills, and provides 
thorough coverage of current concepts in maternity nursing. 
Lippincott 706 Pages Illustrated 1976 $14.75 

standing, Concepts and Principles for Practice 
:ardiovascular surgical nursing is presented in terms of 
1) the "why" tor nursing intenention; 2) the "what to do" 
i.e., nursing actions to solve the patients physiologic 
problems and 3) the "how"-suggested nursing procedures. 
Springer 386 Pages 1976 S 12.50 

Waechter, Blake and Lipp 
Organized by age groups, from infancy to adolescence, 
wilh emphasis on physical and psychosocial growth, devel- 
opment, and healrh care planning for each age. 
Lippincott 834 Pages Illustrated 1976 517.95 


Cosgriff and Anderson, with 31 Contributors 
Will enable the emergency department nurse to assess the 
patient and implement a plan of nursing management. 
Lippincott 488 Pages Illustrated 1975 $15.75 

Discusses the elements 
patient rapport. 
Paper, $5.95 

and means of achieving good staff- 

176 Pages 1976 
Cloth, S 11.50 

Berk, Sampliner, Artzer and Vinocur 
Outlines in step-by-step delaif the diagnostic methods and the 
specific therapy necessary to treal criticall} ill patienls effec- 
tively and efficiently. 
Little,Brown 574 Pages Illustrated 1976 $12.50 

Skydell and Crowder 
Clear directions on what to tell palients to expect, in order 
to spare them unnecessary anxien. 
Little, Brown 248 Pages 1976 $6.95 

E çkert 
Bringing together the experlise of 29 specialists in all aspects 
of acute care, the expanded edition of this well-known 
manual is a must for all professional personnel working 
on Ihe emergency-room team. 
Little, Brown 459 Pages Illustrated 1976 
Paper, $12.50 Cloth, $17.50 
2nd Edition 
Root and Hodkinson 
"This is a book to be included in the library of all schools of 
nursing, where its clearly written text and wonderful sel- 
ection of illustrations will make the learning or orthopaedics 
so very much easier and mor enjoyable." 
-Nursing Mirror 
Blackwell 592 Pages Illustrated 1975 $ 18.50 

APPROACHES: Patient Care and Document<.tion 
Walter, Pardee and Molbo with 16 Contributors. 
Challenges the nurse to explore the development of the 
problem-oriented approach in a clinical situation. 
Lippincott 206 Pages 1976 $6.75 



Representing in Canada: 
). B. Lippincott Company 
Blackwell Scientific Publications 
Little, Brown and Company 
Springer Publishing Company, Inc. 

aid order card with your selections marked. 

Serving the Heatth Profession in Canada Since 1897 
75 Horner Ave., Toronto, Ontario 1\18Z 4X7 


The Canadian Nurse January 1977 

... .......... ... ............ ........ 

ø Key Elements in Adult Education 
The key elements of informal adult 
education are: usefulness, relatedness, 
control, involvement, other people and 
support. All of these elements are built right 
into the adult's informal education and yet they 
can also be incorporated into the formal 
Adults are busy people with many 
responsibilities. They are inclined to spend 
their time and energy learning only those 
things that they consider to be of use to them. It 
is the responsibility of the hospital educator to 
find out from the staff just what skills and 
knowlege would be useful. Knowles does quite 
a thorough job of outlining methods for gaining 
this needed information. Once the educator 
knows what learning the staff considers useful, 
she can plan a program that they will attend 
eagerly. Occasionally the educator has a 
learning program in mind that she considers 
useful for staff; then she must do a "selling 
job." If the staff can readily see where the new 
learning will make their jobs easier or more 
satisfying, they will consider it useful to attend 
the program and learn. 
Adults also tend to be practical people 
who put a lot of stock in their own past 
experiences. Their informal education builds 
from what they already know, toward what 
their experience tells them IS a desirable goal. 
If what we want them to learn can be seen to 
relate directly to their own past experience and 
knowledge and to their future goals, it is much 
more likely that they will learn willingly and 
quickly. If the topic is one that the learners 
consider useful, it is probably related to their 
experience and goals, but even then their 
whole learning experience can be spoiled by 
the use of language and examples that they 
can't relate to or don't understand. It is often 
worthwhile to take the time to have learners 
verbalize relationships and applications as 
they see them. 
When an adult learns informally, he has a 
great deal of control over the situation. He 
decides what the subject matter will be, what 
learning methods and tools will be used, how 
quickly the learning will proceed, and when he 
has achieved his learning objectives. In a 
classroom setting, the learner frequently 
relinquishes all of this control to the teacher. 

tee ru res 
WJrksnops Alms 
course:, pancls 
... .... 
 .... . 
reading swdyitJ9 
thinkinq warcninq TV 
diseus:,ill'J with others - 
, äoif!9 some personal project" 
workll14 on COmmITTees 
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p:c...;,].1 SOflleOt1e '5 rams 
- 5clving a new problem wor14í nq 
with a ncw pcrsot1 gctTing tceclbaeli. 
JaiLy experiences and observations 

The educator who feels secure in her role can 
return much of the control in the formal 
learning situation back to the learners. 
Depending on the nature and breadth of the 
topic, the learners can dedde what sections 
they will study, how long they will spend on 
each section, how many practice sessions 
they will need, what teaching methods they 
prefer, and even the method and content of 
eval uations. 
Some adults feel most comfortable when 
the teacher has all the control, but more and 
more adult learners wish to influence the 
content and nature of their formalleaming 
experiences. As adults, they are accustomed 
to being in control of their leaming and, by 
exercising some of this control in the 
classroom, they are increasing, for 
themselves, the usefulness and relatedness of 
the learning. 
The more involved a learner is in the 
learning situation, the more likely she is to 
thoroughly absorb and efficiently utilize the 
learning. There are three major areas where 
learners can become involved in their own 
formal learning - the content, the process, 
and the problem. 
If the staff has been consulted about what 
content, knowledge or skills would be useful to 
them, they have a sense of involvement with 
the leaming program before they even come to 
class. Once inside the classroom, they need to 
become directly involved with the content. 

1="ormal Educanon 






When we teach skills, we allow ample time for 
learners to handle the equipment and practice 
the skills, but too often we overlook the 
importance of the "hands-on" experience 
when the content of the program is knowledge 
or ideas. Learners need time to grapple with 
new knowledge, debate ideas, draw 
analogies, and relate what is new to what they 
already know. 
The education process is another area 
where hospital staff can become involved. If 
their opinions about teaching formats and 
methods are solidted, and their suggestions 
employed, they have a vested interest in 
making the educational experience 
successful. If they feel that they have a 
responsibility for assisting each other in 
learning, they tend to work harder to avoid 
letting their co-workers down. Regular 
evaluations of the content and process by 
leamers, small group discussions, and 


rn. LanIMJlSn Nurse .JanLWIry l':fl' 



]roup-Iearning or problern-solving projects 
oster the sense of involvernent and 
esponsibility . 
Involvernent with a real-life problem that is 
)f importance to people is perhaps one of the 
nost meaningful of all learning experiences. 
fhomas 3 eloquently argues in favor of the 
earning value of membership in task forces, 
;ommittees and other groups that voluntarily 
'ome together to achieve a specific goal or 
;olve a certain problem. Hospital educators 
l1ight want to seriously consider the 
"'ducational value of staff involvement in 
arious hospital committees. 
Tough discovered that in informal 
3ducation, almost every learner uses four or 
ive other people to help with each leaming 
Jroject. The people used are friends, 
:lcquaintances. colleagues, family members 
:lnd neighbors. They act as resource people in 
Jlanning the learning, selecting the learning 
001, providing information, evaluating the 
earning, stimulating further learning, and 
ffering support and encouragement. In other 
Nords, the adult learner. when learning 
, nformally, uses not just one "teacher". but 
5everal. Interaction with other people. 
ndividually or in groups, seems to be an 

ssential part of the adult education process. 
Many adult learners who would eagerly 
et out to learn anything from astronomy to 
oology in an informal manner, resist going to 
ormal education settings, and resist learning 
Ince they get there. Perhaps childhood 
. xperiences within the school system have left 
/1el11 feeling that they cannot leam, or cannot 
eam anything useful. in a classroom. They 
ay be afraid - afraid of the content, the 
eacher, or their own learning abilities. 
eaming itself is fraught with anxieties and 
I iscouragements. 
When an adult leams on his own. he 
IUIlds in a support system. Friends, family 
embers and "that nice librarian" are used as 

 I urces of support and encouragement. In 

 taft development education classes, the 
eamer is cut off from these supporting people. 
o-workers and superiors may be supportive 
Ir they may be non-supportive. even hostile. 
toward the learner or the learning program. It is 
the educator"s responsibility to help learners 
build support networks within the class and in 
the work area. 

ø The Support Network for 
Adult learners in Hospitals 
The building of a support systern is such 
an important part of a successful staff 
development program that it deserves more 
attention here. It is this system that 
encourages staff to continue learning and 
enables them to use their new knowledge in 
the work environment. 
A pleasant, relaxed atmosphere in the 
classroom is the first step toward dispelling old 
fears about formal education. Course content 
that the learners know, in advance, IS going to 
be useful. and related to their needs and goals 
can eliminate a lot of resistance to learning. A 
teacher who genuinely likes the learners and 
talks in language they understand. without 
being condescending. can increase 
considerably the learners' estirnation of their 
own abilities to master course content. The 
educator becomes a primary person in the 
learners' support network. Other people in the 
class form the ribs of the network. Small and 
large group discussions, and projects done in 
pairs or in groups, are conducive to the 
formation of the classroom support networks 
that are essential for the effective absorption, 
understanding and use of new learnings. 
Too often educators see people eagerly 
and happily learning in the classroom. but 
have "that sinking feeling'. that once the 
learners return to the workplace all will be lost 
because of a lack of support "out there." 
Having staff members come to class In pairs or 
small groups from each area can help develop 
a support network back at work, but it is 
essential that the learners have support from 
key people in the work environment. The 
educator's and the learners' superiors and 
co-workers must not only be in favor of the 
program, but must also be involved. in some 
way, in the planning, process and evaluation of 
the program. If staff development programs 
are to be effective, what the educator does 
outside of class can be more important than 
what she does in the classroom. 
Just as it is easier to avoid hitting the 
iceberg if we know what is below the waterfine, 
hospital educators can plan better staff 
development programs if they understand 
what adults do on their own to continue 
learning. The educator who spends the time 
and effort incorporating these elements into 
her program not only answers many of those 
questions educators must ask themselves 
when planning a program, but is already well 
on the way to providing a rich and rewarding 
experience for learners on their terms. '" 

Jackie Barber, B.Sc.N., MEd., author 0' "The 
Tip of the Iceberg," is an mdependent adult 
educator living in Toronto, Ontario. whose 
present positIons include those of 
co-ordinator and instructor, Continuing 
Education Division, Centennial College of 
Applied Arts and Technology, consultant and 
instructor, Nursing Resource Centre. and 
counsellor and educational consultant, 
Central Abortion Referral, Education 
Services, Toronto. 
She IS a graduate of Atkinson School of 
Nursing, Toronto Western Hospital, and 
receIved her B.Sc.N.. from University of 
Western Ontano. London, and her M Ed. from 
the Ontan.o Institute for Studies m EducatIOn 
Barber observes that "although nurses 
involved in staff development make up only a 
small percentage of CNJ readers, they are 
constantly searching for new ideas and for 
support in lonely positions .. 

1 Knowles, Malcolm S.. The modern practIce of 
adult education: andragogy versus pedagogy. 
Association Press. New York. 1970 
2 Tough, Allen. The adult's learning prOJects. a 
fresh approach to theory and practice in adult 
learning. Toronto. The Ontario Institute for Studies 
in Education, 1971. 
3 Thomas. A., '.Studentship and Membership. 
The Canadian Association for Adult Education 


The Canadian Nu..... January 1977 

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MIke Grenby 

A sharp eye can go a long way toward making 
this time of year considerably less taxing for 
you. For if you can spot the deductions which 
people miss most often, you can be dollars 
ahead when you fill in your income tax return. 
I'm going to summarize here a number of 
points to help you cut your tax bill. I suggest 
you circle the points which specifically apply to 
you. (I've indicated where and how Quebec 
income tax law differs from the federal rules). 
Then clip this article and refer to it when you 
prepare your return, supplementing the 
information here with the guide which 
accompanies the return. 


Make sure you fill in the basic 
personal details correctly. If they don't 
correspond to the information on previous 
years' returns, the computer will get upset and 
interminably delay any refund. Also, incorrect 
marital status or age information can affect 
your deductions. 
" you got married last year, the 
marriage date is important. For it's the 
spouse's net income while married that 
Example: If you were married on Dec. 10, 
your net income for 1976 - while married - 
might be only about $500. So your spouse can 
claim almost the whole married exemption for 
If you earn more than your spouse, then 
you will probably claim the married exemption. 


Another thing /'11 never learn, 
Altho it's plain to some, no doubt, 
Is why they call it a "return" 
When alii do is shell it out. 

Ken Kraft 


Declaring all your income is 
important. If you forget, chances are the 
income tax department won't. You'll eventually 
get a back tax bill, complete with interest and 
perhaps penalties. 
Other income includes scholarships and 
bursaries over $500. and alimony if received 
pursuant to a written agreement or court order. 
If you're self-employed, phone or write to 
your nearest district taxation office for form 
T-2032 (in Quebec, this form is TP-1 and 
should come with the return), or you can draw 
up your own statement to attach to your return. 


A single person can claim the 
"equivalent to married exemption" 
($1,830.- Quebec, $1,900) for a 
Example: A single mother could use her 
youngest child for this exemption; she'd save 
the others for the child exemption section, 
where greater age means a greater claim. (In 
Quebec, the child exemption is only for 
children 16 or older). 
The parent claiming the child 
exemption must declare the family 
allowance as inc?me. (This does not apply in 
Here again, if the child has earned some 
money, use the net income (after deductions 
like tuition, union dues, registered home 
ownership and retirement savings plan- 
RHOSP and RRSP - contributions, Canada 
Pension Plan and Unemployment Insurance 
Commission payments) when calculating the 
child exemption. 




The annual deadline for completion of income tax returns is 
fast approaching. So that you can be sure that you're not 
"shelling out" more than necessary, The Canadian Nurse is 
pleased to oHer readers some tips from a recognized 
authority in the field of money management. 






If you were enrolled in an eligible, 
full-time course last year, you can claim 
$50. a month for every named month, 
irrespective of the number of days. 
Example: You were enrolled from March 
31 to June 3. You can claim four months- 
March, April, May and June - even though 
only 64 days were involved. 
This is one ofthe transferable deductions, 
so if there's a student in your family, you could 
If the student doesn't need to use the 
deduction, any other person claiming the 
student as a dependent (you might be claiming 
your spouse, child, parent, etc.) can use this 
deduction. (Not in Quebec). 




Another transferable deduction is the 
interest-dividend deduction: the lesser of 
the actual amount or $1,000. 
So if your grossed-up dividends (actual 
dividends times four-thirds) plus interest come 
to $400, for example. you claim $400. If the 
total were $1,200, you'd claim $1,000. 
And it one spouse has interest or dividend 
income but little or no other income, the other, 
higher-income spouse may be able to use the 
transferred deduction. 



One accountant I talked to felt that in the 
"employee expense" section, a nurse 
working as an employee might also be able to 
claim the cost of uniforms and other necessary 
equipment such as a stethoscope as "other 
allowable expenses." Keep receipts to back 
up this claim, in case it is allowed - although 
income tax officials I talked to disagreed with 
the accountant on this. 


If you had more than one employer 
last year, chances are you over- 
contributed to CPP (in Quebec, QPP) or 
UIC. There's a place on your return to make 
this calculation. 

You must have an official receipt for 
any RRSP or RHOSP contribution before 
you can deduct it, and if you contribute in 
January or February, you probably won't get 
the receipt until March or even April. 
If you have a refund coming without the 
contribution, go ahead and file your return. 
Then when your receipt arrives, send it off with 
a note dsking the tax people to include this 

Tuition fees over $25 paid to the 
same institution can be claimed by the 
student. This is in addition to the transferable 
education deduction mentioned earlier. 

To claim child care payments, you 
must include the name, address and social 
insurance number if possible of the person 
you paid. You must have receipts on file but 
needn.t submit them. 

If you moved more than 25 miles to a 
new job last year - and this includes a 
student moving to take up a first job - you can 
deduct all expenses connected with the move 
for which you were not reimbursed. 
And don't forget the commission when 
you sold your home. If you did forget this in the 
past, you can ask to have your return 
reassessed; depending on your tax official, 
you might be able to go as far back as the 1973 
tax year. 
All expenses (except commissions) 
related to investments are deductible. Don't 
forget safety deposit box rental and the 
interest paid on the instalment or payroll 
deduction plan to buy Canada Savings Bonds. 
Alimony is deductible only if 
payments are made pursuant to a written 
agreement or court order. 
If you've marked some of these points but 
still feel unsure about preparing your own 
return, consider paying around $25. - 
although the fee could be as low as $10. - to 
have a professional do the job for you. 
Ideally, pick somebody with an 
accounting background and most important, 
somebody who will be around all year. This 
contact with a professional could also help you 
with your general personal finances, not only 
If you do your own return, your local 
district taxation office offers free answers to all 
questions. Unfortunately, this information is 
not binding; at worst, you could get three 
different answers to the same question from 
three different people. 
So if a large deduction is at stake in a fairly 
complex matter, always realize that you might 
get an assessment notice disallowing it and 
don't spend your rebate until you actually get it. 


The Canadian Nurse January 1977 


Recommended reading: 
. Some 15 different income tax department 
booklets, available free by phone or mail from 
your local taxation office. 
. David Ingram's Guide to Income Tax in 
Canada and Thomas Ferguson's What to Do 
When the Taxman Comes. both International 
Self-Counsel Press Ltd.; around $3, each. 
. Preparing Your Income Tax Return, by 
Lachance and Eriks; CCH Canadian Limited; 
around $6, 
. Check your library or bookstore for other 
titles: several of the CCH income tax titles are 
in French, too, '" 

M & M Creations Ltd" 
585 Hadden Drive, 
West Vancouver, B.C, 
V7S 1G8 (Tel: 926-9936) 



If you have any questions on your 
personal finances involving 
investment; Insurance, banking, 
credit or any other such matters 
write to me c/o The Canadian 
While I cannot reply 
individually, I will answer as many 
questions in this column as space 
Letters must be signed, but 
only your initials will be ufled If you 
so request. 

Mike Grenby whose tips on preparing your 
income tax return appear above, IS on the staff 
of the Vancouver Sun, lectures find appears 
regularly on both 10C,,
1 "1al radio and 
television, and has donf: _C", ng lIIork for 
the federal government. 
He is the author of a nationally I> y 
column that he says he writes "to help 
ordinary people understand, manage and gel 
the most from their money." Last year, he 
received the Toronto Press Club and the 
Royal Bank of Canada's National Business 
Writing Award for "the best business column 
in Canada." 
A graduate of the University of British 
Columbia and Columbia University Graduate 
School of Journalism, he is the author of "Mike 
Grenby's GUide to Fighting Inflation in 
Canada" (International Self-Counsel Press 
Ltd.). He and his Australian-born wife, Mandy, 
who is a nurse, live with their son, Matthew, in 
West Vancouver. 

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Maria Rubilie Glenn 

For those who have been doing the clinical 
word search puzzles, here is a new slant - a 
crossword puzzle of nursing and medical 
terms. If you have difficulties, all the words and 
their definitions are taken from Dorland's 
I/Iustrated Medical Dictionary, Philadelphia, 
W.B. Saunders Co., 1965. Answers on page 

2. To throw off, as waste matter, by a normal 
3. The expansive superior portion 
of the hip bone 
4. A disease caused by infection of the 
lungs. It is marked in initial stages 
by symptoms resembling those 
of pulmonary tuberculosis, with erythema 
nodusum. The disease may progress to 
a generalized form. 
5. Combining form meaning new or 
6. Recurrence of an action or 
function at regular intervals. 
7. Removal of all foreign matter and devitalized 
tissue in or about a traumatic or other lesion. 
8. Roentgenography of the vein or veins. 
9. A band of tissue that connects 
bones or supports viscera. 
10. Referring to the eye. 
12. DivIsion into two branches or site 
where a single structure 
divides into two. 
16. A wheal or pomphus: 
18. Device by which different parts of an 
apparatus or instrument are 
19. A combining form meaning 
relationship to tears. 
21. A condition of diminished 
carbon dioxide in the blood. 
22. That portion of the body which 
lies between the tholax and 
the pelvis. 
24. Acronym for common bile duct 
26. A circular area of different 
color surrounding a central 
27. A prefix signifying above, 
beyond or excessive. 
28. A glyceride existing in 
butter or liquid fat with an 
acrid, bitter taste. 
29. Combining form denoting 
relationship to milk. 
31. Any spasmodic movement or 
33. A constricted portion, such as 
the part connecting the head and 
trunk of the body, or the constricted 
part of an organ, as of the uterus 
or other structures. 
34 A circular or rounded flat plate 
or organ. 

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1. A quantity to be administered at one 
time, such as a specified amount of 
4. A skin cancer of a moderate degree of 
8. A membranous fold in a canal or 
passage, which prevents the reflux 
of the contents passing through it. 
10. Excision of one or both testes. 
11. A word meaning not malignant. 
13. A unit of heat. 
14. A test for vision determining if 
the subject is binocular or monocular. 
Named after a physiologist in Leipzig, 
(1834 - 1918). 
15. Material or fact on which a 
discussion or an inference is based, 
17. The tough white supporting tunic 
of the eyeball. 
20. An instrument for measuring the 
eye, especially one determining its 
refractive powers and defects by 
measuring the size of the images 
reflected from the cornea and lens. 
21. The inability to walk due to a 
defect of coordination. 
23. Small transverse lines caused by 
increased density of the bone, seen 
in x-rays at the metaphysis of 
growing bones and due to temporary 
cessation of growth. 
25. The act of drawing toward a 
center or median line. 
26. A word meaning to touch, adjoin or 
border upon. 






28. A sign indicating a definite zone 
of dullness with absence of the 
respiratory sounds in hydatid disease of 
the lungs. Named after an Australian 
physician, (1832-1904). 
29. Color hue between white and black. 
30. Another term for Phimosis. 
32 A ringlike or circu!ar structure 
35. A litter for carrying the sick 
01 injured. 
36. A compound that reacts with a 
base. Sour, having properties 
opposed to those of the alkalies. 
37. Abnormal concretion occurring within 
the animal body and usually composed 
of mineral salts, (plural). 
38. A quality of being marked by stripes, 
a streak or scratch. 
39. The anterior aspect of the head 
from the forehead to the chin inclusive. 

Author's Note 
Maria Rubilie Glenn came to Canada in 1965 
from the Philippines after receiving her basic 
nursing education. She has worked as a 
general duty nurse and as an OR nurse at 
various hospitals before completmg her 
B.Sc.N. at the University of Alberta, 
Edmonton. She states: "I find crossword 
puzzles an excel/ent way to learn new words I 
hope that the readers of The Canadian Nurse 
will enjoy and benefit from solving this 
particular puzzle just as much as I enjoyed 
developing it." 


The Canadian Nurse Januøry 1977 



the nurse's role in health care delivery planning 

Heather F. Clarke 

"Nurses have already made concrete 
suggestions about ways of responding to 
the needs: home care, use of the public 
health nurse, ... etc.... What is needed is 
an unbiased assessment of alternative 
services in terms of their relative low cost, 
effectiveness and social importance. This 
will require a concerted and imaginative 
effort by the consumers of care, the health 
workers and govemment. Nurses are 
willing to enter into such a partnership. "1 
Thus the Canadian Nurses Association 
has supported the necessity for nurses to 
get involved in health care planning and 
challenged other parties to recognize 
nursing input. The real challenge, 
however, is whether nurses will rise to 
their responsibility in health care planning 
with the energy and commitment 
necessary to make significant input. 
For most nurses, involvement in the 
planning of health care services is still a 
new concept. Traditionally we have been 
taught to accept the role of implementor of 
medical and administrative decisions 
and, until recently, were content to stay in 
that role. The nurse's responsibility for 
planning and evaluation of health 
services was rarely mentioned because 
offidally, only medical services existed. 
Today, however, more and more nurses 
are concerned that their professional 
responsibilities go beyond direct nursing 
care to cooperating with others in the 
planning, implementation and evaluation 
of health care delivery. From their unique 
perspective, nurses are beginning to 
challenge the status quo of the health 
care system, to get elected to hospital 
boards, and to agitate for the changes 
they regard as necessary to focus health 
care delivery on the total needs of the 
client rather than the goals of 
professionals (ie. physicians). 
The kind of adaptive planning that 
has been used in the past is outdated and 
ineffective; the need today is for positive, 
innovative, developmental planning. The 
modern health care system must put its 
emphasis on health maintenance and 
prevention, increase its capacity to locate 
those at high risk, and identify groups 
requiring preventive and long-term care. 

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In their struggle to achieve wider recognition and more responsibilities, nurses have been breaking 
into areas from which, in the past, they have been excluded. One of these is the field of health care 
planning. In The Canadian Nurse, March 1976, Bemadet Ratsoy described a strategy the individual 
nurse could use to promote her own ideas for change. Here, Heather Clarke outlines the role of the 
nurse in health care delivery planning and the part played by the RNABC Committee on Health Care 
Delivery in promoting nursing participation in this area. 

Because nurses represent the largest 
group employed in health care delivery 
and are closely associated with the 
consumers of existing services, their 
participation is needed for effective 
management of the community's total 
health care resources, for improved 
communication between the providers 
and consumers of services, and for better 
distribution and quality of health care 
services. Thus our involvement must 
include not only planning for the nursing 
component of health services but for 
those services in their totality. 
To become involved to this extent in 
health care planning, we must change our 
conservative attitudes and recognize that 
our responsibility is to the client, not only 
to the system. We must accept the 
challenge and responsibility for defining 
our roles in broad, functional terms rather 
than narrow and task-oriented ones. The 
preoccupation of nursing with its own 
problems must give way to a closer 
collaboration with others, with extensive 
participation in the community health care 
planning process. 
In B.C., for example: 
. nurses have been elected to hospital 
boards in their community; 
. in one region a nurse has been 
appointed to the Union Board of Health; 
. nurses were included in advisory 
committees to the new 
Maternal-Child-Pediatric Health Care 
. nurses have become part of an 
interdisciplinary team approach to 
community services that involves the 
integration of social work and health 
services. These changes would not have 
happened without the work of individual 
nurses who were forward-looking, 
committed to their cause, and not afraid of 
the hard work involved to make their goal 
a reality. It was only through insistence, 
pressure, follow-up, time and energy that 
even such small victories were won. (See 
Ratsoy, The Canadian Nurse, March 
To further promote the effective 
participation by nurses at the policy- and 
decision-making levels of both elected 

and appointed bodies which affect health 
care delivery, the RNABC Board of 
Directors established the Committee on 
Health Care Delivery in March 1975. At 
the 1975 RNABC Annual Meeting 
delegates and participants identified 
deterrents to nursing involvement in 
health care delivery, the four most 
significant being apathy, lack of 
confidence, lack of knowledge and 
training, and the traditionalism of the 
health care system. Suggestions for 
change involved personal, professional 
and educational committments. Although 
Committee members were interested in 
studying these concems and developing 
specific objectives, they first had to 
answer a number of questions: how do 
we initiate involvement; how much input 
should we have; who should be involved; 
and what are the priorities? 
During the year of its existence, the 
Committee on Health Care Delivery 
studied issues and made 
recommendations to the RNABC Board of 
Directors to: 
. communicate with federal and 
provincial govemments indicating the 
Committee's terms of reference and 
commitment to active involvement in 
health care planning; 
. examine the internal committee 
structure of the RNABC, emphasizing the 
need for coordination; 
. support nursing responsibilities at 
the IXth International Conference on 
Health Education by participation and 
financial support, and 
. promote recognized formal nursing 
input to hospital boards by a change in 
hospital bylaws. 
Many other issues were identified but 
again, priorities had to be set. 
The model of involvement (see 
diagram) the Committee used to promote 
nursing input in health care planning can 
best be illustrated by taking the case of 
changing hospital bylaws. The first step, 
or minimal level of involvement, is 
information sharing. This is an essential 
precondition for participation, since it is 
the only way of ensuring that intelligent 
choices are made. Each nurse must be 

informed about the current situation, past 
experiences and alternative solutions - 
in short, she must know what she is 
talking about. The Committee's concern 
for formal, recognized nursing input to 
hospital boards meant that each member 
had to be knowledgeable about the 
present situation, the results of any 
previous studies and government 
reaction, and the strategies and 
alternatives used in other provinces. We 
studied the hospital bylaws, shared 
information and came up with a 
The second level of involvement, 
consultation, is built upon information. Is 
the informed nurse consulted when 
planners are making investigations and 
recommendations? Is she/he visible to 
the planners? Because those involved in 
planning are still frequently unaware of 
nursing expertise and interest in 
becoming involved, we had to present our 
recommendation on bylaw changes to the 
RNABC Board of Directors and get their 
support to present a brief and 
recommendations to the Minister of 
Health. At the same time, nurses 
concerned with health care planning in 
the community and RNABC officials 
joined committee members in a series of 
activities that served to increase our 
visibility. These included: submitting 
petitions of concern to the government 
and indicating willingness to become 
involved in planning (eg. regarding 
cutbacks in Home Nursing Program); 
submitting letters of concern and 
resolutions to the RNABC Board of 
Directors requesting action; issuing press 
releases and statements regarding 
controversial health issues. 
Involvement at the first two levels is 
relatively passive and it is usually up to the 
discretion of the bureaucracy or 
physicians whether they will take nursing 
interests seriously. As nursing 
involvement becomes more pronounced 
and active, however, there will be a 
movement toward negotiation. This is a 
bargaining situation between planners 
and decision-makers, demanding a 
greater degree of equality. In our society 


The Canadian Nurse 

January 1977 

this stage is largely a political process. 
Can we persuade government to adopt 
our ideas or change their stand? Can we 
get the hospital bylaws altered to include 
formal nursing input to hospital boards? In 
our case, the brief requesting a change in 
hospital bylaws was presented to the 
Minister of Health and his Deputy 
Ministers. They agreed in principle to the 
change, suggesting we return with 
alternative methods after discussing them 
with the medical and hospital 
Negotiation leads to the next level of 
involvement, participation in the 
decision-making process. This has been 
graphically described by Sernadet 
Ratsoy( The Canadian Nurse, March 
1976) in her article about the steps she 
took to promote the implementation of a 
Family-Centered Maternity Health Unit in 
her hospital. 
Only after the nurse has progressed 
through the other levels of involvement 
and established credibility as a planner of 
health care delivery will she reach the 
strongest form of participation in planning 
and decision-making, the Veto. At this 
stage the nurse has attained enough 
respect in her field that a recommendation 
by her withholding support for a certain 
aspect of the plan is accepted by other 
planners as reason enough to alter the 
Successful planning is based on 
policy and strategy as well as on coherent 
gathering and organization of reliable 
data. Nurses, then, must rely on their 
political abilities as well as their 
professional knowledge and skills in order 
to influence the world in which they live. In 
general, nurses have lacked political 
consciousness. We have had the 
potential for power, in fact, we have had 
power, but we have not used it effectively. 
The potential power lying unused and 
dormant in our profession is colossal. 
Writing in Nursing Outlook, JoAnn Ashley 
noted that .....nursing has, and always has 
had, power; it is essentially a social 
phenomenon and its power derives from 
society's recognition of nursing as an 

essential service. The problem lies in the 
ways in which nurses have used, 
misused, and abused their power (or 
failed to use it at all) and in the system in 
which nursing developed and is now 
Power and freedom must always be 
taken. They are never given to oppressed 
groups. Part of the problem lies within 
nursing itself, as Dorothy Hall stressed in 
her address to the RNASC Annual 
Meeting in May 1975: "One of the reasons 
we have been excluded from planning is 
because we may never have indicated 
that we wanted 'in.' Where we have done 
so and continued to be excluded, we have 
perhaps failed because we lacked an 
alternative strategy or because we have 
not been prepared either to persist or 
insist. "4 
Success in politics depends on 
commitment and energy, clear goals, 
thoughtful planning and a sense of humor. 
Nurses must arrive at the conclusion and 
conviction that it is morally right for them 
to seek power, freedom and recognition. 
A clear presentation of our motives is 
essential, devoid of the confusion, 
misconceptions and fears that so often 
accompany efforts to attain these goals. 
Whether it is bedside care, service 
planning and control, or teaching, nurses 
are already involved in decision-making. 
Even if by default, we cannot escape 
certain actions that ultimately make 
services availaule to some and deprive 
others. It is time we started to recognize 
that as nurses we have a dual 
responsibility; as citizens and as health 
care professionals. We must stop being 
passive about health care planning and 
participate directly, in a planned, strategic 
way, anned with knowledge, experience 
and commitment. '" 

1 Canadian Nurses Association 
Commumquette Ottawa, Feb. 25, 1976. 
2 Ratsoy, Bernadet. Shaping a new future. 
Canad. Nurse 72:3:40-41, Mar. 1976. 
3 AShley, Jo Ann. About power in nursing. 
Nurs. Outlook 21:10:637-641, Oct. 1973. 
4 Hall, Dorothy C. Nurses in health 
planning; an international overview. Address 
delivered at the Annual Meeting of the RNABC, 
Penticton, May 1975. Summary. RNASC 
News 7:4:12-13, Jul. 1975. 

1 Ashley, Jo Ann. Power, freedom and 
professional practice in nursing. Superv. Nurse 
6:1:12-14,17,19 passim, Jan. 1975. 
2 Flaherty, Josephine. The presidential 
address. RNAO News 29:1 :5-7, Jun.lJul. 
3 Gilchrist, Joan M. The nature of nursing 
in the health care structure. Nurs. Papers 
5:3:3-13, Dec. 1973. 
4 Klein, Rudolf. Notes towards a theory of 
patient involvement. Ottawa, Canadian Public 
Health Association, 1974. 
5 Scott, Jessie M. The changing health 
care environment; its implications for nursing. 
Amer. J. Pub. Health 64:4:364-369, Apr. 1974. 
6 Simmons, H.J. Community health 
planning - with or without nursing? Nurs. 
Outlook 22:4:260-264, Apr. 1974. 

Heather F. Clarke is herself an active 
promoter of progress on the nursing front. 
She was involved in the &panded Role 
of the Nurse Program of the University of 
British Columbia, is a member of the 
Board of Directors of Vancouver Planned 
Parenthood and of the Social Planning 
and Review Council of B. C. (SPARC) 
and was resource person for the IXth 
International Conference on Health 
Education held recently in Ottawa. She 
was chairman ofthe Health Care Delivery 
Committee of the Registered Nurses 
Association of B. C. and of the program 
committee for the 1975 RNABC annual 
meeting. Her present position is Nursing 
Consultant to Community Human 
Resources and Health Centres in B. C. 
and World Health Organization (WHO) 
Consultant to the University of Iceland 
School of Nursing. 

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Hospital nurses sometimes forget that 
adults as well as children face the thought 
of hospitalization with something less 
than unbridled enthusiasm. For most 
patients, the hospital is, at best, an 
unfamiliar environment full of stressful 
Patients often endure mild stress 
brought on by their illnesses long before 
they must have hospital care. Healthy 
people who fall ill unexpectedly suffer 
almost as much from a loss of self-esteem 
as they do from their physical ailments. 
This triggers such reactions as morbid 
self-pity and hostility directed at nearly 
everyone they encounter. 
Subtle personality changes begin 
almost at the moment the former 
"healthy" person is forced to become 
dependent on others for assistance. 
Everyone knows how the common cold 
I · can turn a once sunny disposition sour. It 
is not surprising, then, that hospitalization 
can produce dramatic personality 
changes. Nurses who recognize these 



 - , 


\ l 
'" J 
...""",. ( .. 
f k \ 
- \ 

changes and understand why they 
happen, are in a position to take 
appropriate measures which will reduce 
emotional stress as much as possible. 
There can be little doubt that nursing care 
which takes into account patient 
personality change is essential to the 
speedy recovery of the sick. 
People who try to ignore an illness, 
often become angry when they must 
accept the truth. For almost a year 
Howard put off having a 
hemorrhoidectomy. Finally, one of his 
co-workers told him he was grumpy and 
he knew he had to do something. The pain 
had increased to the point where it was 
affecting his work and his relationship with 
his co-workers. When he accepted the 
inevitable, he reacted by cursing the fates 
and indulging in self-pity. 
John was in no position to "find the 
time to be sick." He was in agony with an 
inflamed appendix. His only thought was 
to get instant help to relieve the pain. 
Because it was impossible to perform 
miracles, he became hostile towards the 
nurses. When relief finally came he 
regained his self-control and was able to 
accept the reassurances of the nurses. 
Although their experiences were in 
marked contrast, both men displayed the 
same reaction - anger - at the outset. 
Eventually anger will begin to subside as 
hospitalized patients enter an adjustment 

rhe importance of a good nurse-patient relationship cannot be overstated. John and Howard could 
lave been very difficult patients iftheir nurses hadn't taken the trouble to figure out why they behaved 
he way they did. 

During this stage, patients see 
.hemselves as passive recipients of help, 
1aving given up their normal rights over 

heir own bodies. They feel helpless, 
:ompletely dependent on nurses for 
everything. In the acute phase of an 
,lIness patients must have an abiding trust 
In those looking after them. If the trust is 
broken, emotional and physical setbacks 
are highly probable. 
At this point dunng his hospital stay, 
Howard began to worry about what he 
perceived as inconsistencies in his 
nursing care. His anxiety took such a hold 
over him that he was unable to question 
the nurses. 
A flippant reply to a question from 
John had similar consequences. When 
told that a nurse could not help him 
.ecause it was time for her to go home, 
John felt his legitimate concerns were 
being ignored. It took him many days to 
get over the incident; this would not have 
happened ifthe nurse had merely advised 
him that her replacement would look after 
his needs. 

Later, patients begin to feel they are 
participating in their recovery. 
Howard showed an interest in 
learning about necessary diet changes. 
John made less frequent requests for pain 
At this stage, however, patients are 
still a long way from regaining confidence 
in their abilities to look after themselves. 
Both Howard and John felt the nurses 
were neglecting them, an indication their 
ailments still dominated their 
Because normal life styles are 
altered, hospitalization tends to break the 
continuity of life. The bed, food, room, 
people, smells and routines are not like 
home. Family members can often provide 
help to bridge this gap by bringing "home" 
to the hospital. A few personal 
possessi.::>ns, such as photographs of the 
patient's family, news about happenings 
at home, and even a little home cooking 
may help the patient maintain his sense of 
personal identity. 
It is important that nurses know how 
patients react to the hospital scene so that 
they can work with them to set health 
goals. Because this involves the patients, 
they have a greater sense of control over 
their situations. 
Nurses should only get involved in 
areas where patients cannot help 
themselves. The ultimate aim is to create 
a process which allows patients to play a 
greater part in helping themselves. 
However. at this point they are still mainly 
in a receiving position. 

Getting involved 
Nurses could alleviate much of the 
initial trauma t\Jr patients and reduce their 
own workload if they became involved as 
soon after admission as possible. 
The nurse-patient relationship is the 
first step in helping patients. In varying 
degrees nurses must reach out to patients 
and establish workable systems of 
communications. Essentially, patients 
should feel they have the right to ask 
questions and that nurses will respond 
To return to John and Howard for a 
moment, their involvement in nursing care 
helped them to learn what was expected 
of them and how they could help 
themselves increase their understanding 
of treatment plans. All this was necessary 
in the battle to regain their 
Both nurses and patients must be 
honest and concerned about the effects of 
hospitalization. Young nurses should not 
be reluctant to consult more senior nurses 
in order to answer patient questions. The 
student nurse who was answering 
Howard's questions, for example, often 
turned to experienced nurses for the 
answers. Howard found this reassuring 
as he felt the nurse was giving him 
accurate and valuable data and had a 
genuine interest in his well-being. Howard 
expressed a lack of concern from the 
"higher up" nurses who were more 
interested in running the ward, and were 
not available to help the patients. The 
nurse needs to have a relationship that 
indicates her receptiveness to the patient. 
She needs to feel comfortable with him, 
not pass judgment, and be honest to 
herself about her own biases. She must 
listen to the intent of communication - 
not just the words she hears, but also the 
nonverbal messages. 
Finally, openness is extremely 
important. Patients should be 
encouraged to express their feelings, to 
let the nurses know what is bothering 
them, even though it may not be directly 
related to a medical problem. 
In an era when many people feel 
alienated by an impersonal society, 
nursing should once again emphasize the 
value of establishing meaningful human 
relations as an integral part of medical 
care. ... 

Author Gertrude Lakeof Burnaby. B. C. (R.N., 
B.S.N., M.S.N.,J is program co-ordinator for 
the fIrst year of nursing for Registered Nurses 
and RegIstered Psychiatric Nurses at the 
British Columbia Institute of Technology. She 
was responsible for the integration of mental 
health nursmg concepts and skills into the 
BCIT program before becoming co-ordinator. 
Lake is a graduate of the University of British 
Columbia and received her M.S.N. from the 
University of California, San Francisco 
Medical Center. She describes this article as 
"the beginning of my organization of my 
beliefs concerning nursing assessment" and 
says: "I fully believe that assessment for 
emotional components in patient behavior 
and in illness need not be complicated, nor 
time-consuming. Nursing needs to identify a 
select assessment tool which includes critical 
components that will lead to identification of 
problems that are emotional or have 
emotional overtones. " 



160 MAIN ST. S. 

441 1 12 GEORGE ST. N. 


The Canadian Nurse January 1977 




Eliane Lacroix, French translator at 
the Canadian Nurses Association, is 
retiring after 13 years of service. 
During her stay at CNA, she has been 
solely responsible for the translation of 
many articles in L'infirmière 
canadienne and all the official 
documents, annual reports, position 
papers and minutes of C!\IA meetings 
into the French lar-guage. Her 
translation abilities have been utilized 
by the library and Information Services 
at CNA as well as by many 
French-speaking nurses in Canada. 






Before coming to Ottawa, Lacroix 
worked for the purchasing division of 
the French interim government in 
Washington, the French Embassy in 
New York and until t963, for the 
French official tourist board in 
Montreal. She will be greally missed 
by her colleagues who value her 
integrity, dedication, experience and 
sense of humor. 
Henriette Gravelle, formerly with 
the Council on Social Development, 
replaces Lacroix as CNA translator 
and Jacques Paris takes on the 
position of revisor of translation. 

Marlene A. Grantham (R.N., 
Atkinson School of Nursing, Toronto 
Western Hospital; P.H.N., B.Sc.N. 
University of Western Ontario; M.Sc. 
(Admin.), McGill University) has 
recenlly been appointed Director of 
Nursing Service, Victoria General 
Hospital, Halifax, Nova Scotia. 
Leaving her position as Regional 
Director of the VON, she brings a 
variety of clinical and community 
health experience to her new 





Grace Batchelor has been appointed 
Co-ordinator of Continuing Education, 
Division of Community Health by the 
University of Toronto, Faculty of 
Medicine. Batchelor holds a B.Se. in 
biophysics from McGill University and 
a Master of Health Services 
Administration from the University of 
Alberta. She has previously worked as 
a research associate in the 
Department of Clinical Epidemiology 
and Biostatics at the McMaster 
University and as a health consultant 
with Systems Dimensions Ltd. 

Jeff A. Bloom has joined fhe staff of 
the Division of Community Health, 
Faculty of Medicine at the University of 
Toronto. Bloom will be secretariat of 
the Primary Care-Outreach Project 
Committee, a multi-faculty task force 
working on developing a 
demonstration model of a multi-faculty 
primary care unit with involvement 
from the five health science faculties 
and the School of Social Work. 
Previously, Bloom was the 
Evening Administrator at Belleville 
General Hospital, Belleville, Ontario. 

Norah A. O'Leary (R.N., Toronto 
General Hospital School of Nursing; 
B.Sc.N., M.Sc.N., University of 
Toronto) has recenlly been appointed 
Nursing Consultant, Health 
Consultants Directorate, Health 
Programs Branch of Health and 
Welfare Canada. When as!ted to 
comment on her new position, she 
stated, "lis primary objective is the 
improvement ofthe delivery of nursing 
care in institutions. This objective is 
met in a variety of wa:ys. The Nursing 
Consultant acts as a member of a 
multidisciplinary team which assesses 
and makes recommendations for 
improvement in the areas of 
organization, administration, 
operation and patient care delivery in 
an individual hospital. Consultative 
services are offered to provincial 
authorities, and through them to 
individual NUfsing Service 
Departments. There is an opportunity 
to participate on federal-provincial 
working parties developing standards 
for various hospital departments. A 
function which I perceive as very 
important is to facilitate 
communication between nursing 
groups throughout the country." 
O'Leary is President of the 
Ontario Lung Association Nurses 
Section and is past assistant 
professor, School of Nursing, 
Lakehead University in Thunder Bay, 

Phyllis Craig (B.Sc.N., M.H.S.A., 
University of Alberta) has been 
appointed a full-time researcher with 
the Edmonton Local Board of Health. 
She says ooAdministration and 
research in health disciplines should 
be interrelated. The research program 
need not be large, but at least 
decisions are based on some 
statistical findings." 
Craig's nursing career has 
included two years with Health and 
Welfare Canada at Norway House. 
Manitoba; short-term nursing 
assignments in Australia; and work as 
a public health nurse and nurse 
practitioner in Alberta. Her recent 
studies in health services 
administration were in part supported 
by the Canadian Nurses Foundation. 



Anne Dykstra (R.N., Brantford 
General Hospital, Brantford, Ontario) 
recently arrived, with her family, in 
Solo, Indonesia to join MEDICO, a 
service of CARE. She will conduct 
in-service training sessions for 
Indonesian student nurses and 
nursing staff from oullying district 
hospitals. She was previously 
assigned to Malawi as a volunteer for 

New Appointment 

Iris Passey of Vancouver is 
representing the RNABC on the 
Forensic Nursing Committee of the 
Registered Psychiatric Nurses' 


The New Brunswick Association of 
Registered Nurses has awarded 
$4500. in scholarships to students 
enrolled in university nursing 
At the Master's level, Dorothy 
Wasson, R.N. at McGill University 
receives $1500., and Cheryl Doiron 
R.N., enrolled at the University of 
Ottawa receives $500. 
At the Baccalaureate level, 
Carole Estabrooks at the University 
of New Brunswick, Kathryn Suttie, at 
Dalhousie University, and Nicole 
Girouard at the University of 
Moncton, receive $500. scholarships. 
The annual Muriel Archibald 
scholarship was awarded to 
Columbienne Bernard, at the 
University of Moncton and Paula 
Quinn at the University of New 



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The Canadian Nuna January 1977 


Barriers and Facilitators to 
Quality Health Care, by 
Madeline Leininger (ed.). 
Philadelphia: FA Davis Co., 
ApproxImate price $9.60 
Reviewed by Colleen Stainton, 
Assistant Professor, Faculty of 
Nursing, University of Calgary, 
Calgary, Alberta. 

"Health care is an 
expected, essential, and important 
societal imperative in our culture." So 
says Madeline Leininger at the 
beginning of her chapter in this 
Interesting book. While most of the 
content deals with the health care 
system in the United States during the 
past two decades, the book provides 
some thought-provoking reading for 
health professionals in other 
Vanous authors examine major 
issues and generate some common 
themes among the barriers and 
facilitators of health care. Barriers 
tend to be identified as: poor planning; 
lack of coordination and cooperation 
among the rapidly increasing numbers 
of health care professionals; 
inefficient use of economic and 
manpower resources; and changing 
consumer demands. Some facilitators 
suggested are: communication and 
coordination of the professionals; 
Improved health team education; 
improved health policy leading to 
mOle plimary, ambulatory care 
facilities; and changes in the role 
of the health professionals. 
The chapters are arranged 
logically, beginning with an historical 
review of the last decade by Loretta 
Ford, who focuses on health 
manpower use and changes needed. 
The next chapter by John Bryant, an 
Associdte Dean of Medicine, 
examines Health Care Trends and 
Nursing Roles, and provides some 
comments highly relevant to current 
planning in both education and service 
in nursing. He makes interesting 
suggestions for dealing with some 01 
the problems in health manpower 
resources, and discusses nursing as 
an important profession In providing 
the answers to these problems. 

A chapter by a dental professor 
outlines the strengths and 
weaknesses of dentistry as part of the 
health team. especially in the area of 
prevention and early diagnosis of 
medical problems. Nancy Keller, a 
doctorate nurse with a private nursing 
practice, discusses the facilitators and 
barriers to this type of health care 
delivery. She adamantly supports the 
view of the nurse in the extended role 
as a "client-extender" vs. a 
"physician-extender. .. 
Dr. McCormack, a health care 
planner, in a chapter entitled "Public 
Policy and Medical Care Evaluation" 
examines the organizational structure 
ofthe health care system in the U.S.A. 
and the evolution of public policy. He 
evaluates the response of the 
professions and makes a strong plea 
for peer review as a means to ensure 
quality. Then, Drs. Saward and 
Greenlick in "Health policy and the 
HMO," (Health Maintenance 
Organization) comment on the effect 
of the prepaid medical programs 
established in the U.S.A. in 1965 and 
end the chapter with a plea for more 
medical research in the area of health. 
These chapters clearly detail for the 
reader the current health care delivery 
system in the U.S.A. and strenuously 
evaluate it. 
The final three chapters are 
focused on predicted and tested ways 
of improving the present system. 
Madeline Leininger describes health 
care behavior from an anthropological 
perspective in a fascinating chapter 
entitled, "Health Care Delivery 
Systems for Tomorrow: Possibilities 
and GUidelines," strongly advocating 
an open system and consumer choice 
of the type of health practitioner 
appropriate to their health needs. 
The book condudes with two 
chapters by Canadian authors. The 
first is about the nurse practitioner 
program at McMaster University and 
is written by Walter Spitzer and 
Dorothy Kergin. Thefamous Southern 
Ontario Randomized Trial of nurse 
practitioners in doctors' offices is 
described by W.O. Spitzer, M.A. 
Yoshida and B.C. Hackett in the final 
It is notable that the profession of 
Social Work is not represented in the 
list of authors. 

The book was edited with an 
impressive advisory board of nursing 
leaders and a group of special 
consultants from dentistry, pharmacy, 
nursing and medicine. It is a book that 
would be a useful reference for those 
studying health care administration 
and policies. It documents needed 
changes in focus of health care 
delivery from curative to preventative 
care. The nurse practitioner is strongly 
supported as a logical means of 
providing this type of care. 
Health care resellrch is alluded to 
on occasion in this book but one would 
expect it to be mentioned more often 
as a facilitator and for some stress to 
be placed on interdisciplinary health 
care research. 
The book, while only 118 pages 
long, is heavy reading. The 
highly-qualified authors have taken 
considerable care to document the 
content of their chapters. Extensive 
bibliographies follow most chapters. 
This text provides information of 
use to faculty and those in graduate 
programs in all health professions. It 

would probably have somewhat 
limited use by undergraduate students 
but should be available to them. The 
extensive index is an excellent 
reference on special or specific areas 
covered by the several authors. I 
would recommend it as a good 
reference for all those holding office in 
professional associations, for the 
library holdings of all professional 
faculties and schools, and certainly for 
those serving on special action 
committees studying the health care 
delivery system in any country. 

In November, credit for reviewing 
Freedom to Die: Moral and Legai 
Aspects of Euthanasia by O. Ruth 
Russell, was mistakenly given to 
Harriett Hayes, Director of the Miss 
A.J. MacMaster School of Nursing. 
The review was in fact written by 
Sharron Woodworth, Instructor, The 
Miss A.J. MacMaster School of 
Nursing, Moncton, New Brunswick. 

"Your cough is much better since you ve been practising all night" 

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TIMES Mlnnon 

When you're talking about 
adaptability in nursing 
education, you're talking 
about new Mosby texts. . . 


. authoritative 
. up-to-date 
· clinically-oriented 

Comprehensive new texts for your classes 

A New Book! 

The :'\urse and the Family 
This humanistic new text can help you prepare your 
students to tunction as competent and sensitive 
maternity nurses in today's changing society. 
Information is clearly presented in a logical manner, 
following the chronologic order of conception, 
pregnancy, birth and parenthood. Superbly illustrated 
with more than 650 original drawings and 
photographs, this text includes plans for nursing 
intervention based on diagnostic. therapeutic and 
educational objectives. Chapters examine such 
diverse topics as: infertility, contraception, genetics, 
legal aspects ot maternity nursing, ete. Highly 
accessible information, emphasIs on the human 
dimension, qualih ' drawings and photographs -these 
are the elements that make this text uniquely 
significant in the literature of maternity nursing! 
By Margaret Jensen, R.N., M.S.: Ralph C Benson, M.D.; and 
Irene M. Bobak, R.N., M.S. April, 1977. Approx. 832 pages. 
8Y2" x 11",659 illustrations. About $13.15. 



New 2nd Edition! 

A Client Approach to i\:ursing 
This comprehensive text has been signiticantly revised 
to include more information on pathophysiologv and 
assessment techniques. Focusmg on the patient as 
client it retains an integrated approach to adult and 
child care organized according to human need
. with 
emphasis on nursing care. The text has been expanded 
by more than 50%, with 72 tables and more than 100 
new illustrations. You'll find major revisions in the 
chapter on fundamental processes of illness, and ne\\ 
material on: the pathophysiology ot cancer. 
assessment techniques for congenital anomalies, 
pathophysiology of inflammations, and table., on 
cancer-treating drugs and nursing actions. The chapter 
on sexual roles includes ne\\ material on nursing 
assessment of breast cancer and venereal disease. and 
a new section on rape. 
By Janet Miller Barber, R.N., M.S.. Lillian Gatlm Stokes. R.N., 
M.S.: and Diane McGovern Billings. R.N., M.S. March. 1977. 
2nd edition. approx. 1.024 pages. 8" x 11", 738 Illustrations. 
About $18.85. 

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The "Cenadien Nurse Januery 1977 


New 3rd Edition! THE FOUNDATIONS OF 
NURSING: As Conceived, Learned, and Practiced in 
Professional Nursing. By Lillian DeYoung, R.N., 
B.S.N.E., MS., Ph.D.' with 4 contributors. This 
updated text provides students with the most current 
information on respon
ibilities, opportunities, and 
 in professional nursing. Thought-provoking 
chapters cover patients' rights, human rights, abortion, 
euthanasia, death and dying, institutional licensure vs. 
individual licensure, and the problems of transition 
from student to practicing nurse. March, 1976. 316 
pp., 43 i1lus. Price, $9.40. 

NURSING. By Laura Mae Doug/as
, R.N., B.A, MS. 
Thoroughly updated and revi<;ed, this new edition 
reflects contemporary thinking and practices for 
nursing management in all current systems of health 
care. It ofters student
 the necessary leadership skills to 
function In formal and rntormal settings and in a 
variety of relationships. New material covers 
management of nursing service and changes that 
nurses can effect. March, 1977. Approx. 160 pp. 
About $6.25. 


New 3rd Edition! CRITICAL CARE. By Zeb L. Burrell, 
Jr., AB., MD., F.AC.P. and Lenette Owens Burrell, 
R.N., B.S., M.S.N. The new updated edition of this 
classic text (formerly titled INTENSIVE NURSING 
CARE) reviews all aspects of critical care, with 
increased emphasis on physiology. Using an 
organ-system organization, the text covers the 
anatomy and physiology, clinical findings, 
pathogenesis, and treatment for each critical care 
problem discussed. This edition features more material 
on: psychosocial aspects; shock; physiology of the 
respiratory, cardiovascular, and renal systems; plus 
two new chapters on the GI system and hepatic tailure. 
April, 1977. Approx. 424pp., 161 illus.About$12.35. 

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R.N., Ph.D. and-R. Joyce Bain, WN., Ed.D. In a s;ngle 
volume, the authors provide an in-depth guide to 
existing evaluation systems used in nursing 
administration. Based on systems and management 
science concepts, the book examines six quality 
assurance programs: P.O.M.R., care plans, rounds, 
histories, audit, and client evaluation. Organizational 
structure, processes, leadership, and motivation are 
discussed as controls (QAC) for implementing quality 
assurance programs. .July, 1976. 175 pp., 58 illus. 
Price, $6.60. 

MANAGEMENT FOR NURSES: A Multidisciplinary 
Approach. Edited by Sandra Stone, MS.; Marie Streng 
Berger, M.S.; Dorothy Elhart, MS.; Sharon Cannell 
Firsich, M.S.; and Shelley Baney Jordan, M.N. This 
collection of selected readings provides practical 
information on -management and organization 
theories in nursing. Each of the three sections contains 
material relevant tothe organization as a whole and to 
the individual in a leadership or management position 
You'll find details on structure, personnel, and 
economic factors. 1976, 292 pp., 24 illus. Price, 


. authoritative 
· up-to-date 
· clinically-oriented 



I · 
 I, . 

I' '
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. ... 
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NURSING: A Physiologic Approach. By Judith 
Amerkan Krueger, R.N., MS and Janis Compton Ray, 
R.N., M.S. Providing students with a physiologic basis 
for care of patients with endocrine disorders, this new 
text studies all aspects of the endocrine system. 
Discussions cover proper functions and mechanisms 
of dysfunctions, diagnostic procedures and 
pharmacologic treatments. You'lf find chapters on the 
gonads, pancreas, parathyroid, and the thymus and 
pineal glands. August, 1976. 175 pp., 41 illus. Price, 
Rantz, R.N., B.S.N. and Donald Courlial, R.P. T., B.S. 
This new handbook photographically depicts the 
safest and easiest methods of patient handling and 
transfer. Beginning with the fundamental principles of 
patient transfer, basic body mechanics, and bedside 
body mechanics, the manual then provides 
instructions for the transfer of patients with special 
problems or injuries. January, 1977. 148 pp., 250 illus. 
Price, $7.30. 


By Betty S. Bergersen, R.N., M.S., Ed.D.; in 
consultation with Andres Goth, M.D. Now available in 
a new 13th edition, this leading text outlines current 
concepts of pharmacùlogy in relation to clinical 
patient care. Written by a nurse for nurses, the text 
features updated discussions on mechanisms of drug 
action, indications, contraindications, toxicity, side 
effects and safe therapeutic dosage range. Two new 
chapters examine antimicrobial agents and the etfects 
of drugs on human sexuality, fetal development, and 
lactation. February, 1976. 766 pp., 100 illus. Price, 
AND SOLUTIONS: A Programmed Presentation. B\ 
Laura K. Hart, R.N., B.S.N., M.Ed., M.A, Ph.D. 
Updated and expanded, this new 4th edition can help 
students develop skills in calculating dosages and 
solutions. Arranged in a logical, programmed tormat, 
the guide allows students to proceed at their own pace 
and master practical problems they might encounter in 
daily work. New information is included on the 
calculation of children's dosages, insulin dosages and 
intravenous flow dosages. January, 1977. 82 pp., 9 
illus. Price, $6.05. 




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Manual for Nurses. By Marcella M. Strand, B.S.N., 
R.N. and Lucille A Elmer, B.S. In M. T., M. UAS.C.P.). 
Designed for quick reference, this new manual 
provides important information to help your students 
learn to transcribe physician's orders, explain tests to 
patients, collect or supervise the collection of 
laboratory specimens and understand written 
laboratory reports. Selected concepts from physiology, 
basic nursing, and medical-surgical nursing are 
included. March, 1976. 126 pp. Price, $5.55. 
M.D., F.AC.S. and Alice Morel, R.N. The new edition 
of this popular text examines current concepts of 
urologic disease and related nursing management. 
Four new chapters highlight this edition: urologic 
examination and diagnostic tests; urologic equipment 
and its care; urinary ostomy care and appliances; and 
the cystoscopy suite and urologic out patient care. 
Outlines precede each chapter lor easy reference. 
January, 1977. Approx. 384 pp., 217 iIIus. About 

· up-to-date 
· clinically-oriented 
. authoritative 

DOSAGE OF DRUGS: Including Arithmetic. Bv Wen 
M. Anderson, R.N. BS, M.A and Thora M. Vervoren, 
R.Ph., B.S. An effective self-teaching guide, this 
concise workbook relate<; mathematics to common 
solutions and dosages, and provides inlormation 
essential to proper calculation, preparation, and 
administration 01 drugs. Updated throughout. thi
edition places more emphasis on the metric system 
and includes many new problems. The totally 
re\\ritten appendix containo; drug standards and legal 
regulations, metric doses and apothecarv equi\ alents, 
dosage rules lor children, and more. 1976, 176 pp., 11 
ligs. Price, $7.10. 






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The Canadian Nurse January 1977 


PSYCHl:\ TRIC :\"L'RSl:\"G 

Monte /. ,\teldman, ,\1.D.; Gertrude McFarland, R.N., 
M.S.; and Edith Johnson, B.A This pacesetting ne\\ 
book explains how to standardize psychiatric 
treatment and improvethedelivery of psychiatric care. 
The book helps all members of the mental health team 
formulate goal statements and treatment plans. 
Prevention, diagnosis. treatment. and rehabilitation 
are integrated into a comprehensive plan for care of 
the individual and his tamily. July, 1976. 212 pp., BB 
illus. Price, $7.90. 


\ 4th Edit/on! TOTAL PATIENT CARE: 
Foundations and Practice. By Dorothy F. Johnston, 
R.N.. B.S., M.Ed. and Gail H. Hood, R.N., B.S., M.S. 
Fully updated and expanded, this important text 
encompasses all areas of medical-surgical nursing. 
The authors otfer in-depth information on principles, 
techniques, and specific guidelines for nursing care ot 
patienb with di
eases and disorders of various body 
systems. This new edition includes new material on 
pathophysiology, microbiology, pathology, 
intravenous solutions, shock, blood, cardiac 
monitoring. and a new chapter on death and dying. 
February, 1976. 630 pp., 311 illus. Price, $11.85. 

Workbook for Practical Nurses. By Dorothy F. 
Johmton, R.N., B.S., M.Ed. and Gail H. Hood, R.N., 
B.S., M.S. An ideal companion to the above text, this 
practical workbook carefully follows the text chapters 
and presents hypothetical clinical problems for 
students to solve. New key features include: expanded 
vocabulary, additional discussion questions, and 
extended chapter introductions. February, 1976. 20B 
pp., 1 B illus. Price, $6.05. 



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. clinically-oriented 
· up-ta-date 
. authoritative 

THE BODY. By Catherine Parker Anthony, R.N., B.A, 
M.S. and Irene B. Alyn, R.N., Ph.D. Now available in 
hard cover or paperback, this popular text presents 
fundamental information on body structure and 
function. It clearly indicates the relationship between 
normal and abnormal structure, and links normal 
anatomy and physiology to various laboratory tests, 
treatments. and nursing procedures. New chapters 
discuss cells, organs, systems, and tissues; 
fluid-electrolyte balance; and acid-base balance. 
April, 1976. 212 pp., 107 illus. Price, $8.35 (H)i $6.05 



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Orthopaedic Nursing Education 
Day sponsored by the Toronto Area 
Interest Group of the Orthopaedic 
Nurses Association. To be held on 
Feb. 16, 1977 in The Sheraton Centre. 
Toronto, Ontario. For information 
contact: Heather Reuber, 392 Paisley 
Blvd. West, Mississauga, Ontario. 
Motivation for Nurses a conference 
to be held in Calgary, Alberta on Feb. 
17-18. 1977. For information contact: 
Division of Continuing Education, 
University of Calgary, Calgary, 
Alberta, T2N 1N4. 

Communicating through 
Objectives - a one-day conference 
for management and supervisory staff 
to be held Feb. 8 in Toronto, Ont.; 
March 8 in Montreal, P.O.; and March 
10 in Vancouver, B. C. For information 
contact: Practical Management 
Associates, P.O. Box 751, Woodland 
Hills, Ca. 91365. 


Recent Advances in Cardio- 
vascular Nursing to be held on 
March 2-4, 1977 in Saskatoon 
Saskatchewan. Fee: $45.00. For 
information contact: Norma J. Fulton 
Director, Contmuing Nursing , 
Education, Room 4", Ellis Hal/, 
University of Saskatchewan, 
Saskatoon, S7N OWO. 

American Operating Room Nurses 
24th Annual Congress to be held on 
March 20-25, 1977 at Anaheim 
Convention Center, Anaheim, 
California. For information contact: 
AORN Congress Department, 10170 
E. MISSiSSippi Ave., Denver, Colo. 

Audiometry and Hearing 
Conservation in Industry to be held 
on March 22-24, 1977 at the 
Rensselaer Polytechnic Institute, 
Troy, New York in cooperation with 
Albany Medical Center Hospital. For 
further inlormation contact: Office of 
Continuing Studies, Rensselaer 
Polytechnic InstItute, 
CommunicatIons Center 209, Troy, 
New York, 12181. 

Job of Supervision - a one-day 
conference to be held on March 9 in 
Vancouver, B.C.and on March 31 in 
Toronto, Ont. For information contact: 
Pracfjcal Management Associates, 
P.O. Box 751, Woodland Hills, Ca. 


Registered Nurses Association of 
Ontario Annual Convention to be 
held at the Royal York Hotel in 
Toronto, on April 28-30, 1977. For 
information contact: RNAO, 33 P"ce 
St., Toronto, Ontano, M4W IZ2. 

The Nurse Administrator's Role in 
Implementing a Quality Assurance 
Program in any Health Agency. To 
be held on April 4-6, 1977 in Harrison 
Hot Springs, B.C. For information 
contact: Jo-Ann Wood, Continuing 
Nursing Education. 1st Floor, 
Instructional Resources Centre, The 
University of British Columbia. 
Vancouver, B.C. V6T 1W5. 

Ninth Annual Meeting of the 
American Association of 
Neurosurgical Nurses to be held in 
Toronto, Ontario on April 24-28, 1977. 
For information, contact:The 
American Association of 
Neurosurgical Nurses, Business 
Office, 428 East Preston Street, 
Baltimore. Md. 21202. 

National League for Nursing 25th 
Anniversary Convention and 
Exhibition to be held on April 24-27, 
1977 in Anaheim, California. For 
information contact: National League 
for Nursing, 10 Columbus Circle, New 
York, New York 10019. 


Alberta Association of Registered 
Nurses Annual Convention to be 
held on May 3-6. 1977 in Calgary, 
Alberta. For further information 
contact: Alberta Association of 
Registered Nurses, 10256 - 112th 
St., Edmonton, Alberta. T5K 1M6. 

Manitoba Association of 
Registered Nurses Annual Meeting 
will be held at the University of 
Brandon, Brandon, Manitoba on May 

15-17,1977. The theme of the 
meeting will be related to . 'Standards. 
For information, contact: Manitoba 
Association of Registered Nurses, 
647 Broadway, Winnipeg, Manitoba, 
R3C OX2 
Registered Nurses Association of 
British Columbia Annual Meeting to 
be held on May 11-13, 1977 at the 
University of British Columbia in 
Vancouver. For information contact: 
RNABC, 2130 West 12th Ave., 
Vancouver, B. C., V6K 2N3. 
Saskatchewan Registered Nurses' 
Association -Sixtieth Annual 
Meeting to be held at the Hotel 
Saskatchewan, Regina, 
Saskatchewan on May 11-13,1977. 
For information contact: 

Saskatchewan Registered Nurses' 
Association, 2066 Retallack Street, 
Regina, Saskatchewan, S4T 2K2 

New Brunswick Association of 
Registered Nurses Annual Meetir,g 
to be held May 31, June 1-2,1977 at 
Campbellton, New Brunswick. For 
information contact: New BrunswIck 
Association of Registered Nurses. 
231 Saunders Street, Fredencton, 
N.B., E3B 1N6. 

Tenth Communicating Nursing 
Research Conference to be held in 
Denver, Colorado on May 4-6, 1977 
For information contact: WICHE, 
Nursing Research Development 
Program, P. O. Drawer P, Boulder, 
Colorado 80302. 

Director of Labor Relations Service 

Applications are invited for the newly created position of 
Director of Labor Relations Services at Can
Nurses Association, Ottawa. 

Applicants must have had at least five years' experience 
in labor relations as well as knowledge. experience and 
interest in nursing and national organizations. 

The successful applicant will be required to establish 
and direct a labor relations service which includes 
collection and analysis of data, preparation and 
distribution of information and development of relevant 
educational programs. Fluency in English and French 
an asset. 

Interested applicants are asked to submit, in 
confidence, their curriculum vitae before the end of 
January 1977 to: 

Chairman, Selections Committee 
Canadian Nurses Association 
50 The Driveway 
Ottawa, Ontario 
K2P 1E2 


The Cenedlen Nurse Jenuary 1977 

:Libl-al-Y lTpdate 

Publications recently received in the 
Canadian Nurses' Association Library 
are available on loan - with the 
exception of items marked R - to 
CNA members, schools of nursing, 
and other Institutions. Items marked R 
include reference and archive material 
that does not go out on loan. Theses, 
also R, are on Reserve and go out on 
Interlibrary Loan only. 
Requests for loans, maximum 3 
at a time, should be made on a 
standard Interlibrary Loan form or by 
letter giving author. title and item 
number in this list. 
If you wish to purchase a bOOK. 
contact your local bookstore or the 
Books and documents 
1. Aguilera, Donna C. Intervention en 
situation de crise; tMorie et 
méthodologie, Janice M. 
Messick. 2 éd, St-Louis, Mosby, 1976. 
2. American Nurses' Association. 
Professional development in 
psychiatric and mental health 
nursing, Kansas City, Mo., c1975. 
3. -. Affirmative Action Task Force. 
Affirmative action: toward quality 
nursing care for a multiracial society. 
Kansas City, Mo., c1976. 53p. 
4. -. Affirmative action programming 
for the nursing profession through the 
American Nurses' Association, by 
Janice E. Ruffin in conjunction with 
members of the...Ethelrine 
al. Kansas City, Mo., c1975. 55p. 
5. -. Biennial Convention, 49th, San 
Francisco, June 9-14, 1974. Special 
interests - common goals: House of 
Delegates reports 1972-1974, 
Kansas City, Mo., American Nurses' 
Association, c1974. 126p. 
6. L'Association des Infirmières 
Enregistrées du Nouveau-Brunswick. 
Standards du service du nursing. 
Fredericton, 1976. 6p. 
7. Bechtel, Jody. Emergency: a core 
curriculum for continuing education in 
emergency care, al. Lincoln, 
Nebraska, Cardiac Respiratory 
Services, Bryan Memorial Hospital, 
1975. 75p. 
8. Borach, Rose Marie. Elements of 
rehabilitation in nursing. St. Louis, 
Mosby, 1976. 316p. 
9. Braden, Carrie Jo. Community 
health: a systems approach, by...and 
Nancy L. Herban. New York, 

Appleton-Century-Crofts c1976. 
10. Chabner, Davi-Ellen. The 
language of medicine; a worktext 
explaining medical terms. 
Philadelphia, Saunders, 1976. 582p. 
11. Charron, K. Education of the 
health professions in the context of 
the health care system: the Ontario 
experience. Paris, Organization for 
Economic Co-operation and 
Development, 1975. 70p. 
12. Da Cruz, Vera. Bai/liére's 
midwives'dictionary, by...and 
Margaret Adams. 6 ed. London, 
Baillière Tindall, c1976. 303p. 
13. Delivering family planning 
information and services. Winnipeg, 
Dept. of Family Studies, University of 
Manitoba, 1975. 2v. 
14. Drainville, Marie-Claire. Cahier de 
terminologie médicale. Montréal, 
Renouveau Pédagogique, c1976. 
15. Ehrenreich, Barbara. Sorciéres, 
sage-femmes et infirm/éres; une 
histoire des femmes et de la 
medecine, Deirdre English. 
Montréal, Les Ëditions du 
Remue-Ménage, c1976. 78p. 
16. Falconer, Mary W. Patient studies 
in pharmacology: a guidebook. 
Philadelphia, Saunders, 1976. 147p. 
17. -. Traité de pharmacologie, 
p.! a!. Montréal, HRW, c1976. 
18. Frankel, Robert. Radiation 
protection for radiologic 
technologists. New York, 
McGraw-Hili, c1976. 150p. 
19. Froebe, Doris J. Quality 
assurance programs and controls in 
nursing, by...and R. Joyce Bain. St. 
Louis, Mosby, 1976. 161p. 
20. Gagné, Robert M. Les principes 
fondamentaux de /'apprentissage; 
application à /'enseignement, traduit 
par Robert Brien et Raymond Paquin. 
Montréal, HRW. c1976. 148p. 
21. Godfrey, Simon. L'épreuve 
d'effort chez renfant. Montréal, HRW, 
22. Hull, E. Quizzes and questions for 
 Book A. Medical nursing and 
paediatric nursing, by...and B.J. 
Isaacs. London, Baillière Tindall, 
c1976. 152p. 
23. -. Quizzes and questions for 
nurses: Book B. Surgical nursing and 
geriatric nursing, by...and B.J.lsaacs. 
London, Baillière Tindall, c1976. 

24. Jameson, Robert Morpeth. 
Management of the urological 
patient, by...K. Burrows and Beryl 
Large. Edinburgh, Churchill 
Livingstone, 1976. 249p. 
25. Jones, Maxwell Shaw. Maturation 
of the therapeutic community: an 
organic approach to health and 
mental health. New York, Human 
Sciences Press, c1976. 169p. 
26. King's Fund Transatlantic 
Seminar of Nurses, 2nd May...1972. 
Nurses and health care. Collected 
papers edited by Eli2abeth Lucas. 
London, King Edward's Hospital Fund 
for London, 1976. 112p. 
27. Klaus, Marshall H. Materna/-mfant 
bonding; the impact of early 
separation or loss in family 
development, by...and John H. 
Kennell. St. Louis, Mosby, 1976. 
28. Krueger, Judith Amerkan. 
Endocrine problems in nursing; a 
physiologic approach, by...and Janis 
Compton Ray. St. Louis, Mosby, 
1976. 165p. 
29. Lewis, Lucile. Planning patient 
care. 2ed. Dubuque, Iowa, Brown, 
c1976. 209p. 
30. Milbank Memorial Fund. 
Commission. Higher educatIon for 
public health; a report of the Milbank 
Memorial Fund Commission. New 
York, Prodist, 1976. 218p. 
31. National League for Nursing. 
Biennial Convention, New Orleans, 
May 18-22, 1975. Ethnicity and health 
care. Papers...presented during an 
open the NLN Convention 
in May at New Orleans, Louisiana. 
New York, National League for 
Nursing, c1976. 55p. (NLN 
Publication no. 14-1625) 
32. -. State organization planning 
for home health care. 
Papers...presented dunng an open 
forum... at the NLN Convention in May 
1975 at New Orleans, Louisiana. New 
York, National League for Nursing, 
c1976. 47p. (NLN Publication no. 
33. Nelson, Ruben F. W. The il/usions 
of urban man. Ottawa, Ministry of 
State for Urban Affairs, available from 
information Canada, 1976. 76p. 
(Urban prospects no. 8) 
34. One strong voice, the story of the 
American Nurses' Association, 
compiled by Lyndia Aanagan. Kansas 
City, Mo., American Nurses' 
Association, c1976. 692p. 

35. Open Curriculum Conference, 4, 
New York, Sept. 22-23, 1975. 
Proceedings. Edited by Lucille Notter. 
A project of the NLN Study of the Open 
Curriculum in Nursing Education. New 
York, National League for Nursing, 
c1976. 122p. (NLN Publication no. 
36. Ordre des Infirmières et Infirmiers 
du Québec. Commentaires et 
recommandations du bureau. 
Montréal, 1976. 51p. 
37. Patient care guidelines for family 
nurse practitioners, edited by Axalla J. 
Hoole, Robert A. Greenberg and C. 
Glenn Pickard. Boston, Little, Brown 
and Co., c1976. 339p. 
38. Piggott, Juliet. Queen Alexandra's 
Royal Army Nursing Corps, edited by 
Lt. General Sir Brian Horrocks. 
London, Leo Cooper, c1975. 105p. 
39. The psychiatric nurse as a family 
therapist, edited by Shirley Smoyak. 
New York, Wiley, c1975. 251p. 
40. Psychiatric nursing 1946 to 1974: 
a report on the state of the art, 
compiled by Florence L. Huey. New 
York, American Journal of Nursing 
Co., 1975. 61p. 
41. Reeder, Leo G. Handbook of 
scales and indices of health behavior, 
by...Linda Gordon Ramacher and 
Sally GOlelnik. Pacific Palisades, Ca., 
Goodyear, c1976. 540p. 
42. Respiratory technology: a 
procedure manual, by Doris L. 
Hunsinger et al. 2ed. Reston, Va., 
Reston, c1976. 437p. 
43. St. John Ambulance. Safety 
oriented first aid; a multi-media 
programme for Canadian schools, 
col/eges and universities. Ottawa, SI. 
John Priory of Canada Properties, 
c1976. 1 v. (various pagings) 
44. Scherer, K. First survey of nurse 
practitioners and associated 
physicIans methodological manual 
and final report, by...F. Fortin, W.O. 
Spitzer and D.J. Kergin. Hamilton, 
Ont., McMaster University, Faculty of 
Health Sciences, 1976. 252p. 
45. Scott, Joseph W. Woman, know 
thyself. Thorofare, N.J., Slack, c1976. 
46. Turabian, Kate L. A manual for 
writers of term papers, theses, and 
dissertations. 4 ed. Chicago, 
University of Chicago Press, c1973. 
47. United Nations. Development 
Programme. Reports 1975. New 
York, 1976. 88p. 


':. Varney,GlennH.Managementby 
bjectives. Chicago, II., Dartnell, 
c1971. 167p. 
. 9. Wachstein, Jennifer. Anaesthesia 
,md recovery room techniques. 2ed. 
London, Baillière Tindall, c1976. 
15Op. (Nurses' aids series) 
50. Weiss, Curtis E. Communicative 
" .isorders, a handbook for prevention 
; nd early intervention, by...and Herold 
S. Ullywhite. St. Louis, Mosby, 1976. 
51. Werther, William B. Labor 
elations in the health professions; the 
basis of power - the means of 
change, by...and Carol Ann Lockhart. 
Boston, Little, Brown and Co., c1976. 
52. World Health Organization. 
Multmational study of the international 
migration of physicians and nurses; 
country specific migration statistics. 

Geneva, 1976. 392p. 
53. -. Regional Office for Europe. 
Use of operational research m 
European health services; report on a 
Working Group convened by the.... 
Sofia, 7-77 July 7975. Copenhagen, 
1976. 68p. 

54. American Association of Industrial 
Nurses. The student nurse in mdustry; 
guide to use: the industrial medical 
department as a clinical setting for the 
student. New YOr\(, c1958, 1971. 11 p. 
55. -. A guide for developmg 
grievance processing skills. Kansas 
City, Mo., n.d. 1v. (various pagings) 
56. American Nurses' Association. 
Guidelines for short-term continumg 
education programs for college and 
university health nurse practitioners; a 
joint statement of the DivisIons on 

Community Health Nursing Practice 
and Psychiatric and Mental Health 
Nursing Practice of the American 
College Health Association. Kansas 
City, Mo., 1975. 11 p. 
57. -. Guidelines for short-term 
continuing education programs 
preparing adult and family nurse 
practitioners; a statement of the 
Division on Community Health 
Nursing Practice of the American 
Nurses' Association. Kansas City, 
Mo.. c1975. 8p. 
58. -. CommissIOn on Nursing 
Education. Standards for nursing 
education. Kansas City, Mo., c1975 
59. College of Nurses of Ontario. 
Statements re policy on special 
procedures for registered nurses, 
nursing and technical personnel. 
Toronto, 1975. 9p. 

60. Conférence internationale du 
Travail. 61e session. Genève, juin 
1976. Compte rendu provisoire, 
annexes. L 'emploi et les conditions 
de travail et de vie du personnel 
infirmier, septiéme question à /'ordre 
du jour. Genève. Bureau international 
du Travail, 1976. 36p. 
61. Freese, Arthur S. Understanding 
stress. New Yor\(. Public Affairs 
Committee, c1976. 20p. (Public affairs 
pamphlet no. 538) 
62. Hodgeman, Karen. Adaptations 
and techniques for the disabled 
homemaker, by...and Eleanor 
Earpeha. 4ed. Minneapolis, Mn., 
Sister Kenny Institute, 1976. 30p. 
(Sister Kenny Institute, Rehabilitation 
Publication no. 710) 
63. International Labour Conference 
61st session, Geneva, June 1976. 
Provisional record; appendices; 

-'-, t- 

, . 
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The Cenedlan Nu"e January 1977 

Lil)I-III-!] ['"I)(ltlte 

Employment and conditions of work 
and life of nursing personnel. Seventh 
Item on the agenda. Geneva, 
International Labour Office, 1976. 
64. New Brunswick Association of 
Registered Nurses. Nursing service 
standards. Fredericton, 1976. 6p. 
65. Nurse's role in blood component 
transfusion procurement. Bethesda, 
Md., National Institutes of Health, 
1975. 27p. (DHEW Publication no. 
66. Ozimek, Dorothy. Relating the 
'Jpen curriculum to accountability in 
baccalaureate nursing education. 
New York, National League for 
Nursing, c1976. 10p. (NLN 
Publication no. 15-1631) 
67. The primary care nurse in the 
hospital emergency department. A 
/Oint brief to the Government of 
Ontario from the Ontario Hospital 
Association, Ontario Medical 
Association, College of Nurses of 
Ontario, Registered Nurses of 
Ontario, College of Physicians and 
Surgeons of Ontario. Toronto, 1975. 
1v (various pagings) 
68. The Provincial Council of Women 
of Manitoba. Ad hoc committee on 
rape. Brief on rape. Winnipeg, 1975. 
69. Rogers, Peter D.lnfluenza alert; a 
seH-instructional unit. Philadelphia, 
Davis, c1976. 21 p. 
70. Saskatchewan Registered 
Nurses' Association. Continuing 
education for nurses in 
Saskatchewan: policies, procedures, 
standards for approval. Regina, 
Sask., 1976. 6p. 
71. Taunton, Roma Lee. 
Characteristics of short-term 
continuing education pediatric nurse 
practitioner /associate programs 
existing September 1974 - June 
1975, by...and John M. Soptick. 
Kansas City, Mo., American Nurses' 
Association, c1976. 18p. 
72. Wright, Leora R. A report on the 
advanced course in mental health 
and psychiatric nursing, Nov. 1, 1975 
- Apr. 3D, 1976. Fredericton, New 
Brunswick Association of Registered 
Nurses, 1976. 28p. 

Government documents 

73. Advisory Council on the Status of 

Women. Report 1975/76. Ottawa, 
1976. 32p. 
74. Le bureau de la Coordonnatrice, 
Situation de la femme. La femme 
canadienne. 2éd. Préparé par 
Recherches et Décisions Québec 
Limitée, Toronto. Ottawa, 1976. 278p. 
75. Conseil consultatif de la situation 
de la femme. Rapport 1975/76. 
Ottawa, 1976. 32p. 
76. Health and Welfare Canada. 
Health Protection Branch. Alcohol 
problems in Canada: a summary of 
current knowledge. Ottawa, 1976. 
67p. (Its Technical report series no. 2) 
77. -. Selected nutrition teaching 
aids. Ottawa, Information Canada, 
c1976, 62p. 
78. International Development 
Research Centre. Low-cost rural 
health care and health manpower 
training; an annotated bibliography 
with special emphasis on developing 
countries. Ottawa, c1975. 2v. 
79. Labour Canada. Occupational 
safety and health: a bibliography; 
selected holdings of technical library, 
accident prevention division. Ottawa, 
Supply and Services Canada, 1976. 
80. Office of the Co-ordinator, Status 
of Women. Women in Canada. 2ed. 
Prepared by Decision Marketing 
Research Ltd. Ottawa, 1976. 256p. 
81. Parlement. Chambre des 
Communes. Comité permanent de la 
santé, du bien-être social, et des 
affaires sociales. L'enfance maltraitée 
et negligée. Ottawa, 1976. 90p. 
82. Parliament. House of Commons. 
Standing Committee on Health, 
Welfare and Social Affairs. Child 
abuse and neglect. Ottawa, 1976. 
83. Santé et Bien-être social Canada. 
Direction générale de la protection de 
la santé. Service éducatifs. 
Documentation sur I'hygiène 
alimentaire. Ottawa, Information 
Canada, c1976. 67p. 
84. Secretary of State. The 
organization and administration of 
education in Canada. Ottawa, 
Minister of Supply and Services 
Canada, c1976. 219p. 
85. Travail Canada. Sécurité et 
hygiéne professionnelles; 
bibliographie; choix de volumes de la 
bibliothéque technique, division de la 
prévention des accidents. Ottawa, 
Approvisionnements et Services 
Canada, 1976. 144p. 

United States 

86. Division of Nursing. Graduation 
and withdrawal from RN programs; a 
report of the nurse career-pattern 
study, by Lucille Knopf. Bethesda, 
Md., 1975. 130p. (DHEW Publication 
no. (HRA) 76-77) 
87. -. High school seniors' attitudes 
and concepts of nursing as a 
profession, by Melvin H. Rudov. 
Maurice T. Wilson and Karen F. 
Trocki. Bethesda, Md., 1976. 167p. 
(DHEW Publication 110. (HRA) 76-35) 
88. -. Surveys of public health 
nursing 1968-1972 prepared by 
Division of Nursing in cooperation 
with the Association of State and 
Territorial Directors of Nursing. 
Washington: U.S. Dept. of Health 
Education, and Welfare, Public Health 
Service, Health Resources 
Administration, Bureau of Health 
Manpower, Division of Nursing; for 
sale by the Supt. of Docs., U.S. Gov't. 
Print. Off., 1976. 337p. (DHEW 
Publication no. (HRA) 76-8) 

89. Interagency Conference on 
Nursing Statistics. Abstracts of 
studies; health manpower 
references. Bethesda, Md., U.S. 
Public Health Service, 1975. 30p. 
(DHEW Publication no. (HRA) 75-24) 

Studies deposited in CNA 
Repository Collection 

90. Kirstine, Myrtle Lavina. A study of 
health and related needs of senior 
citizens in two housing complexes, 
conducted in the regional 
municipality of York Newmarket, 
Ont., York Regional Health Unit, 1976. 
86p. R 
91. Leonard, Linda Gaye. 
Husband-father's perceptions of 
labour and delivery. Vancouver. 
1975. 165p. (Thesis - British 
Columbia) R 
92. Pelletier, Julia M. The effects of 
continuity in nurse-patient 
assignment among a selected group 
of preoperative aortocoronary bypass 
patients. Toronto, 1976. 125p. (Thesis 
(M.S.N.) - Toronto) R 

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your help 

When patients need private duty 
nursing in the home or hospital, 
they often ask a nurse for her 
recommendation. Health Care 
Services UPJohn Limited is a re- 
liable source of skilled nursing 
and home care specialists you 
can recommend with confidence 
for private duty nursing and home 
health care. 
All of our employees are carefully 
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Each is fully insured (including 
Workmen's Compensation) 
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Care can be provided day or 
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For complete information on our 
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The Canadian Nurse January 1917 

('I.lssi f.i
..L \(I'.
I.t iS


Employment Opportunity - Athabasea Health Unit No 16 requores 
a Senior Public Health Nurse for the Athabasca Office. B.Sc. qualifi- 
cation preferred and expenence essentaal. Salary range vanes accor- 
ding to qualdlcatlon and expenence Apply Immediately to: V 
Markowski. Administrative/Seely.. Box 1140. Athabasca, Alberta 
TOG OBO Phone 1-403-675-2231 

British Columbia 

Head Nurse - Psychlatnc Unrt - POSition requires a R.N. with 
psychiatric training and expenence In Ward Management. The unit is 
16 beds with 6 day care Unlts_ It IS a new umt opening In January or 
February 0/ 1977 The posrtlon becomes available November 1. 1976. 
Salary according to RNABC conlract Apply in writing to The Oorector 
of Nursing. Mills Memorial Hosp.tal, 2711 Telrault Street, Terraæ. 
British Columbia V6G 2W7 

Registered and Graduate Nurses required lor new 41-bed acute 
care hospital 200 miles north of Vancouver. 60 miles trom Kamloops 
Limited furmshed accommodahon available. Apply Director 01 Nurs- 
Ing. Ashcroft & District General Hospital. Ashcroft British Columbia 

Registered Nurses with psychlatnc training or expenence, for new 
psychIatric unot opening January or February 1977 Salary according 
to RNABC contract Please apply In wntlng to. The Oorector 0/ Nursing. 
Mills Memorial Hospital. 2711 Tetrault Street, Terrace. Bntlsh Colum- 
bia. V6G 2W7 

General Duty Nurses lor modern 41-bed hosp.talloeated on the 
Alaska Highway Salary and personnel pohCles In accordance with 
RNABC Accommodation available In residence Apply Director of 
Nursing, Fort Nelson General Hospital. P.O. Box 60, Fort Nelson. 
British Columbia. VOC 1 RO. 

British Columbia 

General Duly Nurses for modern 35-bed hospital located In south- 
ern B.C. 's Boundary Area with øxcellent recreation facilities. Salary 
and personnel pOliCIes In accoroance wllh RNABC. L.omfortable 
Nurse S home Apply Director of Nursing. Boundary Hospital. Grand 
Forks. Brilosh Columbia. VOH 1 HO 


Director of Nursing for generalized public health program with Invol- 
vemenl in leaching at universIty level and partlClpetion In community 
research projects, Education to level 0/ Master s Degree applicable to 
public health nursing and several years expenence In the service !Ield 
in supervisory capacity. Salary negotiable and commensurate with 
these requirements. Usual fnnge benefits. Apply to: MIss F. Abbons, 
Secretary, Board of Health, Borough of East York Health Unot. 550 
Mortimer Avenue, Toronto, Ontano, M4J 2H2. 


Registered Nurse required for co-ed children s summer camp In the 
Laurentlans (seventy miles north of Montreal) from late June until late 
August 1977. Call (514) 467-5177 or wrlle: Camp MaroMae. 5901 
Fleet Road. Hampstead. Montreal. Quebec. H3X 1 G9. 


Generel Duty Nurse requored for 6-bed hospital in Edam, Saskat- 
chewan. Experience preferred and references needed. To start De- 
cember 1.1976. with salary according to S.U.N. Apply to: Oorectorof 
Nursing. Lady Minto Union Hospital. Box 176, Edam, Saskatchewan. 


The School of Nursing 
Selkirk Mental Health Centre 
is offering a 
Post - Basic Course in 
Registered Nurses currently licensed in 
Manitoba or eligible to be so licensed. 
The course is of nine months dl,ration 
September through May and includes 
theory and clinical experience in hospitals 
and community agencies, as well as four 
weeks nursing of the mentally retarded. 
Successful completion of the program leads 
to eligibility for licensure with the R.P.N.A.M 
For further information please write 110 
later than June 15/77 to: Director of 
Nursing Education, School of Nursing, 
Box 9600, Selkirk, Manitoba R1A 2B5 



This program has been designed to prepare clinicians and researchers for the expanding function of nursing in our rapidly developing 
health care services. 




Graduates will be prepared to incorporate either option within careers in the Teaching of Nursing or the Development and 
Management of Nursing Service. 

Either a Baccalaureate degree in Nursing comparable to B.Sc. (N) or B. N. from McGill; or Baccalaureate degree comparable to B.A. or 
B.Sc. offered at McGill 



2 years for those with nursing degrees 
3 years for those with non-nursing degrees 

Director, School of Nursing 
Master's Program 
3506 University Street 
Montreal, P.Q. H3A 2A7 


United States 

Registered Nurses - Hospotal ope..ngs available lor new graduates 
and expenenced nurses (R N. s). Wllfing to re-Iocateto Umted States 
No charge to the app
cants We arrange everythng 'or you I I Please 
contact MISS Shore (416) 449--5883. 

Come South! Sunshine, warmth & beaches - mild winters. We 
represent hundreds of clIents Ihat are SeekIng Canad'an to JOIn 
IhEllr slalt. Third na!Jon entrants need not apply. These situabons are 
vaned. and Income levels are excellent. up to $14.000 (U.S.) lor 
ICUICCU supel'Vlsors. $13.500 lor shllt Sup9""SOfS a:1d $12,000 lor 
general duty stalt nlKSes Some S,tuatlOns may State llcen- 
sue exam. however. most are available Without exarmnabon. One 
year comnlltmenl. round-tnI' AIr Fare. hous'"g aSSIStance and Visa 
H-1 appllcatJOn assIstance IS provided. Our lee IS paid also - you 
have no obligation whatsoever For complete details, send your re- 
sume with photograph and lull partIculars, \0: Medical Search. 3274 
BUCkeye Road, AIIanta. GeorgIa 30341. 

Registered Nurses - Hurtey MedIcal Center IS a weø eQUipped 
mOàem. 6Oo-bed teaching hospital o"erong complete and spec""ized 
servICes IOf !he restorabon and preservatJOn 01 the community s 
heatth. 11 aJso offers onentabon, In-service and continuing eOJcatlon 
lor employees. It IS Involved In a buIlding prOQl"am to prov,de bener 
surroundings 'or pallenlS and employees. We have Immedate ope- 
mngs for regIStered nurses In such speoatty Units as Cardlo- Vascular. 
Operating Rooms. Nursenes. and General Medical-SurgICal areas 
Hurley Medical Center has excellent salary and ITlnge benefits Be- 
come a part 01 our progressive and well qualified work lorce Today_ 
Apply. Nursing Department Mr. Garry Viele. AssOCIate Director 01 
NursIng. Hurley Medocal Center. Flnt, MIChIgan 48502 Telephone 
(313) 766 0386 


Nurses - RNs -'mmodlste OpenIngS in AOrlda & Arkansas-If 
you are Expenenced or a recent Graduare Nurse we can oHer you 
poSItIonS with excellent salaries 01 up to $1160 per month plus all 
benefits Not only are there no lees to you wtlatsoever for plaCIng you 
but we also proVIde complete Visa and Licensure assistance ar also 
no cost to you. Wr
e ,"}mediately lor our appkcallon even d there are 
other areas ollhe U S lhat you are Interested In. We WIll ca. you upon 
rec8lpt 01 your applicallon In order to arrange for tlosp
WIndsor Employment Agency Inc.. P.O. Box 1133, Greal Neck New 
York 11023 (516-487-2616). 

Hospital Affiliates 
International Inc. 


Un ited 

Hospital Affiliates International, the leader 
in the field of hospital management. has 
over 70 hospitals in operation or under 
construction in 23 States. 
On-going opportunities exist for Canadian 
citizens who have graduated from an 
accredited Canadian School of Nursing. 
Openings exist in all clinical areas. 
If you are considering working in the 
United States, and have an interest in 
associating yourself with one of our 
hospitals, please contact our Canadian 
representative who will be pleased to 
discuss your specific needs. All enquiries 
will be treated in confidence and should 
be directed to: 

365 Evans Ave.. Toronto M8Z 1K2 

The Montreal 
Children's Hospital 

Registered Nurses 
Nursing Assistants 

Our patient population consists of the 
baby of less than an hour old to the 
adolescent who has just turned 
seventeen. We see them in Intensive 
Cale. in one of the Medical 01 Surgical 
General Walds. or in some of the 
Pediatric Specialty areas. 
They abound In OUI clinics and their 
numbers increase daily in our 

If you do nollike working with children and 
with their families, you would not like It 

If you do like children and their families, 
Wp would like you on our staff. 

Interested qualified applicants should 
apply to the: 

Director of Nursing 
Montreal Children's Hospital 
2300 Tupper Street 
Montreal, Quebec. H3H 1P3. 


Nurse faculty members required for the 
1977 -78 academic year for a School of 
Nursing, within a Faculty of Health 
Sciences. The School is an integral part of 
a newly developed Health Sciences 
Centre where collaborative relationships 
are fostered among the various health 
professions and clinical appointments 
can be arranged. Requirements: Master's 
or Doctoral degree, with clinical specialist 
preparation or experience and/or 
preparation in teaching preferred, In adu" 
health, medical-surgical or pediatrics. 

Application, with a copy of curriculum 
vitae and two references to: 

Dr. D. Kergin 
Associate Dean (Nursing) 
Faculty of Hea"h Sciences 
McMaster University 
Hea"h Sciences Centre 
1200 Main Street West 
Hamilton, Ontario 
L8S 4J9 

with us 

, .... 
. ... It l 
.. 4: þ 

-=- -- 

. \
... \:., 
, - 
í .. 

' \.- 



\ . 

University of Kentucky 
Medical Center - 

a progressive tertiary care center 
oriented toward service, teaching 
and research. 

We offer-travel and moving 
allowance-salary commensurate 
with experience and 
education-three weeks paid 
orientation-three weeks 
vacation-10 holidays-sick leave 
benefits-paid tuition 
benefits-inservice and continuing 
education-professIonal freedom 
and growth. 

Wnte to. 
Mrs. Dorothea Krieger 
Assistant to the Director for Staffing 
Department of Nursing 
University of Kentucky 
Lexington, Kentucky 40506 

Name _ 
City _ 
State Zip _ 
Date of Graduation _ 

An Equal OppOltunily Employet 


Director School of 
Reporting directly to the Executive 
Director, assumes the responsibility for 
the organization and administration of 
ongoing accredited diploma nursing 
e Appropriate Master's Degree 
preferred, but applicants possessing a 
Baccalaureate in Nursing will be 
. Previous experience in the 
administration of an aCCredited nursing 
education program a necessity. 
Please forward, in confidence, a 
complete resume of experience and 
qualifications including expected 
salary to: 
Mr. T.!. Bartman 
Executive Director 
Misericordia General Hospital 
99 Cornish Avenue 
Winnipeg, Manitoba R3C 1A2 

Head Nurse 

The Position: 
Directing an acti-"e 40 bed surgical unit 
with opportunity for future advancement. 
The Person: 
Should have a Baccalaureate degree with 
a clinical specialty and/or administrative 
The Hospital: 
Central Alberta location in an expanding 
regional hospital. 
The City: 
30,000 population half way between 
Edmonton and Calgary and close to the 
best in skiing and recreation centres. 

Please send complete resume to: 
Director of Personnel 
Red Deer General Hospital 
Red Deer, Alberta 
T 4N 4E7 

Registered Nurses 
and Certified Nursing 

Required for 340 bed level IV Hospital 
Must be eligible for Saskatchewan 
Salary in line with neighbouring provinces 
and under review. 

For details apply to: 
The Personnel Department 
Souris Valley Extended Care Hospital 
Box 2001 
Weybum, Saskatchewan 
S4H 2L7 

The Cenedlen Nurse 

Foothills Hospital, Calgary, 
Advanced Neurological- 
Neurosurgical Nursing 
for Graduate Nurses 

A five monlh climcal and academic 
program offered by The Department of 
Nursing Service and The Division of 
Neurosurgery (Department of Surgery) 
Beginning: March, September 

Limited to 8 participants 
Applications now being accepted 
For further information, please write 
Co-ordinator of In-service Education 
Foothills Hospital 
140329 St. N.W. Calgary, Alberta 
T2N 2T9 

Operating Room 

Applicant must have a thorough 
knowledge and training in current 
operating room management and 
procedures including personnel 
selection, good communication and 
interpersonal relationship skills. 

Baccalaureate degree required. 

Please apply, forwarding 
complete resume to: 

Director of Personnel 
St. Joseph's Hospital 
London, Ontario 
N6A 4V2 

University Faculty 

Applications are invited for the position of 
Assistant or Associate Professor of 
Community Health Nursing in a basic 
University program enrolling 
approximately 200 students. 
A Master's degree and expertise in 
practice are required. Preference given to 
candidates with graduate preparation 
and/or experience in Maternal Child 
Nursing. Teaching experience in a 
umversity program is desirable. 
Candidate must be eligible for registration 
in Ontario. 
Salary commensurate with qualifications. 
Apply in writing giving curriculum 
vitae to: 
Dr. E. Jean M. Hill 
Dean and Professor 
School of Nursing 
Queen's University 
Kingston, Ontario K7L 3N6 

January 1977 

University of Ottawa 
School of Nursing 

Positions available for the 1977-78 
academic year In: 
. Medical-Surgical Nursing 
. Maternal and Child Nursing 
e Psychiatric Nursing 
. Community Nursing. 
Master's degree in clinical specialty and 
teaching experience required. Preference 
will be given to bilingual candidates 
(Flench and English). Salary 
commensurate with preparation. 
Send curriculum vitae and references to: 
School of Nursing 
University of Ottawa 
770 King Edward Avenue 
Ottawa, Ontario 
K1 N 6N5 

Head Nurse 

with preparation and/or 
demonstrative competence in 
Psychiatric Nursing and 
Management functions, required for 
Head Nurse appointment. To be 
responsible for participation in the 
organization, initiation, and the 
management of a New Psychiatric 
In-patient Unit. 

Please apply, forwarding 
complete resume to: 
Director of Personnel 
Stratford General Hospital 
Stratford, Ontario 
N5A 2Y6. 

Clinical Specialist 

We require the services of an articulate, 
dynamic nurse with a Master's Degree 
and a Major in Medical-Surgical nursing. 
We are a 300 bed Hospital Complex on 
the verge of a major expansion. We are 
close to fine recreational and cultural 
The nurse in this position will work closely 
with our Medical Staff, Administrative 
Staff and Staff Nurses to further develop 
patient centered projects. The salary and 
benefits are based on the qualifications 
and experience of the applicant. 
For further information about this 
opportunity, please forward a 
complete resume to: 
Director of Personnel 
Red Deer General Hospital 
Red Deer, Alberta 
T4N 4E7 



.' .'


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can go a long way 
. .. to the Canadian North in fact! 

Canada's Indian and Eskimo peoples in the North 
need your help. Particularly if you are a Community 
Health Nurse (with public health preparation) who 
can carry more than the usual burden of responsi- 
bility. Hospital Nurses are needed too... there are 
never enough to go around. 
And challenge isn't all you'll get either - because 
there are educational opportunities such as in- 
service training and some financial support for 
educational studies. 
For further information on Nursing opportunities in 
Canada's Northern Health Service, please write to: 

I Medical Services Branch I 
Department of National Health and Welfare 
Ottawa, Ontario K1 A OL3 
I Name I 
I Address I 
I City Provo I 
I . . Health and Wella'e Sanlé el Bien-êlre social I 
Canada Canada 



Open to both 
men and women 



.. (' 





Health and Welfare Canada 


Join the team providing health care to the residents 
of the Northwest Territories. 
Medical Services, Northwest Territories Region 
will be offering a number of term positions for qua- 
lified and experienced nurses. 
Positions are available at nursing stations, 
health centres and hospitals for the period, May 
through September. 
Knowledge of the English language is essential. 

NOTE: Permanent positions are also available 

For more information, clip and mail the coupon 
below to: 

Personnel Administrator 
Medical Services 
Northwest Territories Region 
Health and Welfare Canada 
14th Floor, Baker Centre 
10025 - 106th Street 
Edmonton, Alberta T5J 1H2 
Or call collect: (403) 425-6787 
· Name 
I Address I 
I City I 
L Postal Code ...I 


m oo 


Nursing Instructors Required 


. are imaginative, creative, interested in professional growth and 
. like working with students and like to teach 
. are not afraid of hard work 
. are satisfied with nothing short of excellence 
. are interested in earning good salary 


. a Baccalaureate or Masters Degree in Nursing 
. several years of practical field experience 


. that is student centered, promotes self-paced learning 
. that is open to creative change and experimentation 
. that aims to graduate nurses that are current, (and responsible) 
and have the capacity for growth 

Apply to: 
Mr. C.L. Dick 
Vice President 
Medicine Hat College 
Medicine Hat, Alberta 
T1 A 3Y6 

Director of Nursing 
Dryden District General Hospital 

Dryden District General Hospital is a 75 bed accredited 
hospital located in the Town of Dryden, population 7,000, area 
served 15,000. Dryden is midway between Winnipeg and 
Thunder Bay on the Trans-Canada highway in the midst of the 
Patricia Tourist Region. Transair provides twice daily jet flights 
to Toronto and Winnipeg. 

Many cultural and recreational opportunities are available to 
residents of and visitors to the community. 

Experienced applicants with a university degree will be given 
preference but experience in a supervisory capacity in a larger 
hospital will receive consideration. Employees benefits are 
generous, salary is negotiable. Employment is available 

Please write or telephone to: 
Dryden District General Hospital 
Dryden, Ontario Phone: 807-223-5261 

The Cønødiøn Nurse Jønuary 1977 

Index to 
January 1977 

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Advertising Representatives 
Richard P. Wilson 
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THE CLINIC SHOEMAKERS · Dept. CN-2, 7912 Bonhomme Ave. . St. louis, Mo. 63105 

,hø @oøod'ou 

The official journal of the Canadian 
Nurses Association published 
monthly in French and English 

February 1977 

Volume 73, Number 2 

Input 6 
Calendar 8 
News 10 Idea Exchange: 
Education in the 
Electronic Age Manuel Escott 15 
Books 50 The Father's Side: 
A Different Perspective 
on Childbirth Unda Leonard 16 
LJbrary Update 52 Nursing the Acutely Psychotic Patient Janet BerezowskÏ 23 
Frankly Speaking Patricia McMeekan 26 
Singing, Signing, Smiling MaryDean Samanski 28 
A Professional Imperative MUriel A. Poulin 30 
Reproduction and 34 
the Test Tube Baby L. Pakalnis, J. Makoroto 
The Self-Care Unit: 
A Bridge to the Community Patricia Barrington 39 
Care of the Rape Victim 
in Emergency Sandra LeFort 42 
Mrs. B. and Me Heather Sproul 46 









These days, fathers are getting in on 
the act at every stage of the growth 
and development of their offspring as 
this month's cover photo Illustrates. 
On page 16, author Linda Leonard, 
describes the reaction of some fathers 
to their participation in the events 
leading up to and including the bi rth of 
their children. Cover photo by Miller 
Services limited. 

The vIews expressed in the articles 
are those of the authors and do not 
necessarily represent the policies of 
the Canadian Nurses Association. 

ISSN 0008-4581 

Indexed In International Nursing 
Index Cumulative Index to Nursing 
lItelature Abstracts of Hospital 
Management Studies. Hospital 
literature Index Hosp.lal Abstracls 
Index Medlcus. The CanadIan Nurse 
is available In microform from Xerox 
University MIcrofilms, Ann Albor. 
Michigan, 48106. 

The Canadian Nurse welcomes 
suggesllons for articles or unsolicited 
manuscripts. Authors may submit 
fInished articles or a summary of the 
proposed content. Manuscripts should 
be typed double-space. Send onglnal 
and carbon. All anlcles must be 
submilled for the exclusive use of The 
CanadIan Nurse. A biographical 
statement and return address should 
accompany all manuscripts 

ð Canadian Nurses Association. 
'=7 50 The Dnveway. Ottawa Canada. 
K2P 1 E2. 

Subscnption Rates: Canada: one 
year. 58.00; two years. 515.00. 
Foreign: one year. 59.00; two years, 
517.00. Single copies: 51.00 each 
Make cheques or money olders 
payable to the Canadian Nurses 

Change of Address: Nolice should be 
given in advance. Include previous 
address as well as new. along with 
regIstration number, in a provincial! 
territorial nurses' aSSociation where 
applicable. Not responsible for 
journals lost in mall due to errors in 

Postage paid in cash at third class rate 
Montreal. P.O. Permit No. 10,001. 

 Canadian Nurses Association 


The Canadian Nurse February 1977 

.-(-'."I)(-(.t i


Of all the "helping professions," 
nUlses must be among the most 
keenly aware of the toll that poverty 
exacts in terms of our vital human 
resources. Every day, in the people 
we care for, we see the effects of 
dietary deficiencies, under-nutrition 
and all the other deprivations 
associated with life below the poverty 
line. We recognize that a link exists 
between malnutrition and anemia,low 
resistance to infectious diseases, 
mental retardation and mental illness. 
We know also that the deprivations 
arising from a marginal existence 
present a special threat to certain of 
our patients - the very young, the old, 
the disabled and the expectant 
mother. We have read that studies of 
the children of the poor (Montreal, 
1969) prove that half of them show 
signs of emotional problems and that 
almost one third of them exhibit 
symptoms of malnutrition, retarded 
growth (height and weight) and 
psycho-motor retardation. 
The poor, in fact, survive in an 
environment that almost prohibits 
mental and social well-being and has 
an even more disastrous effect on 
their physical health. A representative 
of the Canadian Medical Association 
has estimated that "the 20 percent of 
the population that are poor suffer 
something like 75 to 80 percent of 
major illnesses." 
It is now more that five years 
since the Senators who travelled 
across Canada listening to the poor 
and studying their submissions, tabled 
their report, "Poverty in Canada." In 
this, they acknowledged the existence 
in Canada of "an ugly sub-culture 
within society" whose inhabitants 
generally receive inferior educational, 
medical, cultural and information 
services and whose children, "the 
most helpless victims of all, find even 
less hope in a society whose 
social-welfare system from the very 
beginning destroys their dreams of a 
better life." 
Since then, as the Economic 
Council of Canada points out, the 
poverty gap has widened. Between 
1965and 1974, according to the ECC, 
the only group to increase its share of 
total pre-tax income was the top 40 
percent of families and individuals. 
The share of the bottom 40 per cent of 
families and individuals in fact 
decreased from 16.2 percent in 1965, 
to 14.9 percent in 1974. 

When the Poverty Committee 
submitted its report in 1971, the 
principal recommendation of its 
members was for acceptance by 
Canada of the right of all of its citizens 
to an adequate minimum income. The 
Senators saw implementation of a 
Guaranteed Annual Income as the 
first and most crucial step in a 
comprehensive program to combat 
poverty in Canada in the Seventies. 
Political and social acceptance of the 
GAl would, they believed, depend on 
the extent to which-Canadians and 
their elected leaders recognized some 
form of income maintenance as a 
viable alternative to the chaos of the 
existing welfare system. 
The future of the Canadian social 
security system is still up in the air. A 
blue-ribbon task force with 
representatives from both the 
departments of Health and Welfare 
and Finance is currently studying 
possible changes in the tax system to 
provide a guaranteed income for the 
two million working Canadians who 
live in poverty. The proposed system 
could be expanded later to cover all 
Canadians who now depend upon the 
welfare system for much of their 

.......... i .1 

M. Anne Hanna 
Assistant Editors 
Lynda Ford 
Sandra LeFort 

Production Assistant 
Mary Lou Downes 
Circulation Manager 
Beryl Darling 
Gerry Kavanaugh 
CNA Executive Director 
Helen K. Mussallem 

Canada's Minister of Health and 
Welfare has indicated that he 
considers some form of supplement 
program for the working poor and a 
support program forthose who cannot 
work "inevitable." The question now is 
"when?" It would seem the time is ripe 
for this kind of fundamental and 
long-delayed shakeup In our 
approach to promoting the health and 
well-being of our fellow-Canadians. 

. . 




How long is it since you made 
your fi rst hesitant attempts to apply the 
nursing skills you had learned In a 
classroom to the care of your "very 
own patient?" Every nurse has 
memories - some bitter, some sweet 
- about herfirst real patient. We think 
that, no matter how long it's been, 
Heather Sproul s story about Mrs. B. 
will strike a familiar chord for all our 

In our society, the victim of a rape 
is often the victim of bureaucratic, 
unfeeling medical and judicial 
systems as well. In hospitals, the 
treatment given to a woman who has 
been raped often leaves a great deal 
to be desired, especially in the area of 
emotional care. This month, Care of 
the Rape Victim in Emergency on 
page 42 provides some guidelines for 
those nurses who deal with rape 
Is the fetal monitor an expensive 
and risky toy, or a means of reducing 
North America's alarmingly high 
perinatal mortality figures? Next 
month, author Ellen Hodnett 
investigates what researchers have to 
say about the use of fetal monitors in 
assessing fetal health just prior to 





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The Canadian Nurse February 1977 

The Canadian Nurse invites your 
letters. All correspondence is subject 
to editing and must be signed, 
although the author's name may be 
withheld on request. 



Appropriate clinical content 
I share the conviction, stated in 
the last paragraph of "Perspective, 
(October, 1976), that to be 
professional we need a special body 
of knowledge and skills that only 
members of our occupational group 
possess. Because nursing is a 
practice discipline, it follows that the 
development and communication of 
appropriate clinical content is a 
mandatory activity for nurses. I 
therefore expected you to request 
clinical articles on the etiology, 
incidence, signs, symptoms and 
treatment of phenomena which 
nursing practitioners manage 
independent of other disciplines. 
However you request articles that 
derive from a medical rather than a 
nursing classification scheme, Le. 
cancer, arthritis, dermatology. Most of 
the data you solicit, Le., etiology, 
incidence, signs and symptoms of a 
disease, are already available in 
medical journals. A simpler version of 
that knowledge is contained in the 
journals for persons working in the 
physician's assistant role. 
Thus I must ask: What are your 
criteria for classification of a clinical 
nursing article? Would you be 
interested in receiving clinical articles 
that deal with nursing diagnoses that 
reflect patient situations that arise 
because the person has a disease 
state but that do not use a medical 
classification scheme for 
identification? For instance, I do work 
with patients who have cancer. I need 
an understanding of this disease 
process as it relates to my patients' 
coping with both the disease and the 
medical regimen. My major skills and 
knowledge as a nurse focus on 
helping these persons and their 
families to: manage their fears of 
death; adapt to changes in body 
image that come from treatment and 
disease progression; and manage the 
experience of pain and changes in 
their activities of daily living that 
ensue. Persons who have the disease 
label called 'cancer' may experience 
any or all of these phenomena but so 
will patients suffering from other 
diseases. My understanding of these 
phenomena comes from the research 
and theory of many disciplines and 
articles on these nursing concems 
and cannot be discussed under 
categories such as the 'dermatology 
patient. ' 

I also consider the management 
of client situations in which there is no 
disease state present appropriate 
clinical content for the discipline of 
nursing. Would articles on this topic be 
included or excluded in your 
- Jessie Mantle, R.N., London, 

The editor replies: 
Our request for clinical articles 
based on a medical classification 
scheme is largely an historical 
accident: the most common complaint 
we receive about deficiencies in 
editorial content is the absence of 
"clinical articles like the ones in 
the American nursing journals." In our 
attempt to analyse the journal overthe 
past five years in response to this 
criticism, we grouped published 
articles according to disease states, 
There was no intent to "put down" 
nursing diagnoses. We do feel, 
however, that in order to be complete, 
a clinical article should provide nurses 
with enough information about the 
pertinent etiology, incidence, signs, 
symptoms etc. of a disease state to 
serve as a handy review. Our feeling is 
that this knowledge is useful in 
developing the larger concerns that 
you mention - such as helping 
patients and their families to adjust, 
adapt, manage etc. 
- M.A.H., Editor. 

Essential or non-essential? 
As a Public Health NUlse I am 
experiencing anger and frustration. 
For years we have been docile 
handmaidens, reluctant to speak out 
against those changes that seem to 
have caused only deterioration in the 
health field. I feel our govemment and 
our communities need to be educated 
about our role as public health nurses 
in a growing society. Health care costs 
have increased; too often I have been 
told that the reason lies in the high 
salaries of registered nurses. 
If public health nursing were used 
to its fullest potential, it could definitely 
reduce the cost of health care. I have 
read that those employed at the Liquor 
Control Board are classified as 
providing "essential services"; public 
health nurses are not. 
As members of a community, 
preventive medicine should be 
foremost in our minds. The public 

health nurse functions as a 
coordinator, counsellor, nurse, and 
teacher of health-related topics. We 
are involved with every age group, in 
the schools, homes, hospitals and 
places, of employment. 
If our doctors utilized our 
services, many of the patients that 
arrive in their offices could be seen by 
a public health nurse. If, after she 
assessed the situation, she felt a 
doëtor should be consulted, then a 
referral would be made. Immunization 
should be looked atler by the health 
agencies, not by a doctor who should 
be utilizing his time in a different 
manner. Mothers should be 
encouraged by the doctors to contact 
the public health nurse if they are 
concerned about feeding and care of a 
child. If the problem is one that 
requires the doctor's expertise, then 
an appointment could be made to 
have the child seen. Family planning 
and birth control clinics should be well 
attended - why should a 
gynecologist see patients who could 
be taught at these clinics? 
A comment has been made that 
we are too highly specialized for what 
we do. My reply to that comment is- 
since we are well trained to cope as 
members of the health team, then 
direct added responsibilities towards 
public health nurses rather than to a 
highly paid, overworked group. 
- Mrs Vi Krmpotich, R.N., P.H.N., 
Sault Ste. Marie, Ontario. 

CUring career cramp 
As a group, nurses now have 
considerable security and a trend 
toward complacency is 
understandable. We have achieved 
considerable gains in terms of 
remuneration but from a personal or a 
professional standpoint, a monetary 
definition of success isn't quite 
sufficient. Success is almost 
impossible to define but a working 
answer would be that we are a 
success as individuals and as a 
profession if we get to do what we 
perceive to be our work. This would 
seem to involve determining what our 
work is, but need not be a 
once-and-for-all decision: the many 
roles of nursing are still evolving. 
FOllowing the Boudreau 
Committee report there was animated 
discussion of this point. Almost every 
issue of The Canadian Nurse carried 

reports of pilot projects where nurses 
were attempting new patterns of 
practice. It's fashionable today to say 
that nurses are overpaid, but the other 
side of that statement is that nurses 
are underutilized. Yet, the basis for 
professional expansion has been 
afforded us in the flexibility evident in 
deciding what responsibilities for 
patients a nurse may undertake. 
Pilot projects are clearly 
necessary, but often when the novelty 
wears off one feels that the new range 
of practice is confined to the area 
where the pilot project was 
undertaken. It has not spread to other 
areas or institutions. Of course there is 
conflict inherent in what must be done 
for the patient - how it should be done 
and by whom. The old hierarchical 
values tell us conflict must be avoided 
at all costs, and yet conflict can be 
productive and even fun. In any case, 
it's not possible to eliminate it entirely 
from organizations Attempts to avoid 
it block our development and lead to 
career cramp. The Pickering Report 
indicates that the public are affording 
us the chance to enlarge our practice. 
We cannot expect to continue 
doing things in the old familiar way. 
What is needed now is that each nurse 
deliberately attempts to improve and 
expand her own performance to fill the 
void between expensive medical care 
and those patient needs that can be 
handled by the nurse. This grass roots 
effort seems one way of increasing our 
productivity and testing our ability and 
acceptability. The present level of our 
remuneration carries a responsibility 
to demonstrate our increased worth to 
our employers and the community. 
- Gabriel/e Monaghan, R.N., 
Bel/eville, Ontario. 

Wrong subject! 
Notice of my dissertation was 
published in the December issue of 
the journal. My name was recorded as 
Haliburton, John C. 
John Haliburton is my cousin and 
is currently doing research on 
changing manure to gas at the 
University of Manitoba, Winnipeg. 
My topic is evaluation of the new 
curriculum in the nursing school. 
Would you please make the 
appropriate corrections. 
-Jane C. Haliburton, Ed. D., Director 
of Education, Yarmouth Regional 
Hospital, Yarmouth, N. S. 



The weD informed student 
becomes a competent nurse. 


New 3rd Edition! 
Continuing to provide a person-centered approach to 
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Students will find details on care for many specific 
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summary glossaries, cross-references, and questions and 
By Sue Rodwell Williams, M.P.H., M.R.Ed., Chief, Nutrition Pro- 
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Instructor, Human Nutrition, Chabot College, Hayward, Califor- 
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California, Berkeley, Calif. March, 1977. 3rd edition, approx. 720 
pages, 7" x 10", 134 illustrations, including original drawings 
by George Strauss. About $13.40. 

A Learning Guide for Students. By Sue Rodwell 
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By Alice Lorraine Smith, A.B., M.D., F.C.A.P., F.A.C.P., Pro- 
fessor of Pathology, The University of Texas Health Science 
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Smith, A.B., M.D., F.C.A.P., F.A.C.P. April. 1977. 
Approx. 192 pages, 71/2" x 10 1/2", 46 illustrations. 
About $7.25. 


, ," } 





\ \4 


The Canadian Nurse February 1977 


March April Eleventh Annual Symposium on June 
Intrauterine Development and Fetal 
Call for Research Papers for Registered Nurses Association of Management to be held on May 5-7, Registered Nurses Association of 
Workshop on Research Ontario Annual Convention to be 1977 at the Cross Keys Inn, Baltimore. Nova Scotia Sixty-Eighth Annual 
Methodology in Nursing Care to be held at the Royal York Hotel in Maryland. For information, write: Dr. Meeting to be held at the Isle Royale 
held In Ottawa, Ontario, on 9, 10, 11 Toronto, on April 28-30, 1977. For John W. C. Johnson, Dept. of Hotel, Sydney, Cape Breton, on June 
November 1977. Workshop theme: information contact: RNAO, 33 Price Gynecology and Obstetrics, The 23-24, 1977. Theme: Crisis in Care. 
Management of methodological St., Toronto, Ontario, M4W IZ2 Johns Hopkins Hospital, Baltimore, For information contact: Frances M. 
problems encountered in research in Maryland 21205. Moss, 6035 Coburg Road, Halifax, 
nursing care. Attendance by invitation. Interviewing for Nurses to be held N.S. B3H 1Y8. 
Papers which describe methodo- April 4-6, 1977 in Lethbridge, Alberta. Alberta Association of Registered 
logical problems encountered are Fee: $55. Contact: Division of Nurses Annual Convention to be Fifth Canadian Regional 
invited from nurses conducting Continuing Education, UniversIty of held on May 3-6, 1977 in Calgary, Conference of the International 
research in nursing care Initial Calgary, Calgary, Alberta, T2N 1 N4 Alberta. For furtherinformation Childbirth Education Association 
inquiries regarding preparation of contact: Alberta Association of sponsored by the Edmonton 
papers accepted until 15 March 1977; leadership in Nursing, to be held Registered Nurses, 10256 - 112th Childbirth Education Association on 
completed submissions must be April 13-15, 1977 in Lethbridge, St., Edmonton, Alberta, T5K 1M6. June 28-30, 1977. Theme: Nurturing 
postmarked not later than 20 April Alberta. Fee:$55. Contact: Division of the Family. Participants include 
1977. For information contact: Marion Continuing Education, University of Manitoba Association of Ashley Montagu. For further 
Kerr, Research Officer, The Canadian Calgary, Calgary, Alberta, T2N 1N4. Registered Nurses Annual Meeting information contact: Mrs. Pat Walker, 
Nurses Association, 50 The Driveway, will be held at the University of Information Officer, ECEA. 15 Glacier 
Ottawa, Ontario, K2P 1 E2. Symposium on Coping with Cancer Brandon, Brandon, Manitoba on May Crescent, Sherwood Park, Alberta, 
to be held at the Royal York Hotel, 15-17, 1977. The theme of the TBA 2YI. 
Writing Workshop for Nurses to be Toronto, Ontario on April 24-26, 1977. meeting will be related to "Standards." 
held in Toronto on March 3-4, 1977. Topics to be discussed include: For information, contact: Manitoba 8th Annual Meeting of the Canadian 
Fee: $50. Contact: Dorothy Brooks, cancer prevention, screening for Association of Registered Nurses, Association of Neurological and 
Chairman, Continuing Education cancer, helping the newly diagnosed 647 Broadway, Winnipeg, Manitoba, Neurosurgical Nurses to be held at 
Programme, Faculty of Nursing, 50 patient, palliative care and other R3C OX2. the Loews Concorde Hotel in Quebec 
St. George Street, Toronto, Ontario, related topics. Contact your provincial City on June 14-16, 1977. Contact: 
M5S IAI. nurses' association for details and Registered Nurses Association of Ms. Beth Cook, 59 Warren Road, 
registration forms. British Columbia Annual Meeting to Toronto, OntarIO. M4V 2R9. 
The Nurse Practitioners' be held on May 11-13, 1977 at the 
Association of Ontario Annual The Director of Nursing and Clinical University of British COlumbia in Annual Meeting of the Canadian 
Workshop to be held at the Nursing Research, to be held in Vancouver. For information contact: Society of Allergy and Clinical 
Sunnybrook Medical Centre, Toronto Toronto on April 21-22, 1977. Fee: RNABC, 2130 West 12th Ave., Immunology to be held in Hamilton, 
on March 10 and at McMaster $50. Contact Dorothy Brooks, Vancouver, B.C.. V6K 2N3. Ontario on June 16-18. 1977. For 
University, Hamilton on March 11, Chairman, Continuing Education information contact: Executive 
1977. For information contact: Megan Programme, Faculty of Nursing, 50 Saskatchewan Registered Nurses Secretary, Canadian Society of 
McCullough. 32 Chelvin Drive, St. George Street, Toronto, Ontario, Association -Sixtieth Annual Allergy and Clinical Immunology, 
Georgetown, Ontario L7G 4P9. M5S IAI. Meeting to be held at the Hotel 1390 Sherbrooke Street West, 
Saskatchewan, Regina, Montreal, Quebec. 
Budgeting for the Head Nurse and May Saskatchewan on May 11-13,1977. 
Coordinator to be held March 14, For information contact: 1977 Annual Canadian 
1977 in Calgary. Fee: $20. Contact: Saskatchewan Registered Nurses Physiotherapy Congress to be held 
The Division of Continuing Education, Twenty-Second Annual Association, 2066 Retallack Street, on June 10-20, 1977 at the Edmonton 
University of Calgary, Calgary, Convention of the American Regma,Saskaæhewan, S4T2K2 Plaza Hotel, Edmonton, Alberta. For 
Alberta, T2N 1 N4. College of Nurse-Midwives to be information, write: Yvette D. Claveau, 
held May 2-4, 1977 at New York City's New Brunswick Association of Publicity Chairman, 1977 C.PA 
Nursing Assessment: Keystone to Statler Hilton Hotel. For information Registered Nurses Annual Meeting Congress, 5507 - 115th Street, 
Care Planning to be held March contact: American College of Nurse to be held May 31, June 1-2, 1977 at Edmonton, Alberta T6H 3P4. 
23-25 , 1977 in Calgary, Alberta. Fee: Midwives, 100 Vermont Avenue, Campbellton, New Brunswick. For 
$51. For information contact: The N. w., Suite 1210, Washington, D.C. information contact: New Brunswick Multi-Disciplinary Burn 
Division of Continuing Education, Association of Registered Nurses, Management Seminar to be held at 
University of Calgary, Calgary, Cardiology '77 - Fourth Annual 231 Saunders Street, Fredericton, the Misericordia Hospital in 
Alberta, T2N 1 N4. Seminar on Advanced Intensive N.B.. E3B 1N6. Edmonton, Alberta on June 19-20, 
Cardiac Care to be held on May 1977. For further information contact: 
Annual Meeting of the Canadian 16-18,1977 at the Park Plaza Hotel, Cancer Nursing Update - 1977. Mr. Ken Mark, Director, Rehabilitation 
Nurses Association, 31 March 1977, Toronto, Ontario. For information, Progress, Problems and Prospects Medicine. Misericordia Hospital, 
Ottawa. Contact: The Canadian contact: Conference and Seminar to be held in SI. Louis, Missouri on 16940 - 87th Avenue, Edmonton, , 
I Nurses Association, 50 The Driveway, Services, Humber College of Applied May 9 - 10, 1977. For information, Alberta T5R 4H5. 
Ottawa, Ont., K2P 1E2. Arts and Technology, Box 1900, contact: Sidney L. Arje, M.D., The 
Rexdale, Ontario M9W 5L7. American Cancer Society, 777 Third I 
Avenue"New York, 10017. 


TIMES Mlnnon 



ONARY CARE UNIT. By William P. Hamilton, M.D. 
and Mary Ann Lavin, R.N., M.S.N., M.S.(H.S.A.) 
This important 2nd edition can help you prepare stu- 
dents to make necessary decisions in the CCU. General 
principles and practical techniques for care of patients 
with cardiac pain, irregular pulse, and low blood pres- 
sure are carefully described. Actual coronary care situa- 
tions illustrate each problem-providing relevant 
clinical experience. A new chapter discusses patient 
education. 1976, 168 pp., 126 illus. Price, $7.10. 





CORONARY CARE: A Program. By Marielle Ortiz 
Vinsant, R.N., B.S.; Martha 1. Spence, R.N., B.S., 
M.N.; and Dianne Chapell Hagen, R.N., B.S. This pro- 
grammed book reviews all major problems associated 
with acute myocardial infarction. New material 
discusses hemodynamic monitoring and drug therapy 
for shock and heart failure. 1975, 244 pp., 439 illus. 
Price, $8.35. 

The Basis for Intensive Nursing Care. By Sheldon B. 
Korones, M.D. This important new edition can inform 
your students of the most up-to-date advances in peri- 
natal medicine and nursing care of the high-risk infant. 
Explaining the "why's" behind many specific proce- 
dures, Dr. Korones emphasizes an understanding of 
intrauterine antecedents. A new chapter on thermo- 
regulation adds to the value of the revision. June, 1976. 
280 pp., 113 illus. Price, $11.50. 



By Barbara Lang Conway, R.N., M.N. This new text 
can alert students to the signs of pediatric neurologic ab- 
normalities. It first presents a clear account of 
neurologic physiology; then offers informative discus- 
sions on normal neurologic development; and assess- 
ment techniques for testing children with learning disa- 
bilities, emotional disturbances, and hyperkinesis. Feb- 
ruary, 1977. Approx. 416 pp., 102 illus. About $15.25. 
Impact of Early Separation or Loss on Family Develop- 
ment. By Marshall H. Klaus, M.D. and John H. 
Kennell, M.D.; with 3 contributors and 8 critical com- 
mentators. This timely book focuses on the earliest 
physical and sensory relationship a baby develops with 
his parents; the factors that enhance or inhibit this proc- 
ess; and the effects of this relationship on the growth of 
the family. August, 1976.275 pp., 49 illus. Price, $9.40 
(H); $6.60 (P). 



ER: Guidelines for Practice. By Fernando]. deCastro, 
M.D., M.P.H., F.A.A.P., F.A.P.H.A.; Ursula T. 
Rolfe, M.D., F.A.A.P.,; and Janice Kocur Drew, R.N., 
B.S., P.N.P.; with 3 contributors. Provide your stu- 
dents with a current guide to ambulatory pediatrics with 
the help of this text. Discussions examine the entire pro- 
cess of assessment and treatment, including many speci- 
fic clinical problems. Some of the new material covers 
hematology, neonatology, parasitology, and school 
health. 1976, 220 pp., 8 illus. Price, $6.85. 

By Marcene L. Erickson, R.N., B.S.N., M.N. This well 
illustrated new book provides a systematic approach to 
developmental screening and assessment of infants and 
pre-school children. It carefully shows how to use many 
specific assessment tools and how to plan the manage- 
ment of behavioral problems caused by developmental 
changes. July, 1976. 280 pp., 161 illus. Price, $8.95. 

By Charles William Hubbard, M.P.H., M.A. The new 
2nd edition of this popular book offers a concise presen- 
tation of four areas of sexuality: contraception, abor- 
tion, sterilization and venereal disease. It features a new 
chapter on psychosocial aspects of birth control and 
new information on risk factors of various contracep- 
tive methods, counseling, and the "new" venereal 
diseases. January, 1977. 258pp., 47illus. Price $6.25. 


The Canadian Nurse February 1977 


Drug ad watchdog 

Canada has become one of the first 
countries in the western world to 
introduce a preclearance program for 
pharmaceutical advertising directed 
towards the health professions. The 
newly created Pharmaceutical 
Advertising Advisory Board (PAAB) 
which will coordinate the program was 
federally incorporated as a non-profil 
organization in January 1976. The 
Board brings together representatives 
from the health professions of 
medicine and pharmacy, the 
Association of Medical Media, the 
Canadian Advertising Advisory Board, 
the Consumers Association of 
Canada and the pharmaceutical 
industry. The Board's functions will 
include the preclearance of 
advertising of pharmaceuticals, the 
establishment of criteria for the 
approval of proposed advertising and 
the administration of program policy. 

" ....,.. 




The permanent Chairman of the 
advertising preclearance program is 
Dr. I.W.D. Henderson FRCS(C). Dr. 
Henderson is a Fellow of the Royal 
College of Surgeons (Canada) and a 
widely-known specialist in clinical 
pharmacology in Canada. He is 
presently chairman of Clinical 
Research and also of the Pharmacy 
and Therapeutics Committee at the 
Ottawa General Hospital, and 
associate professor in the Department 
of Surgery and Pharmacology at the 
Faculty of Medicine, University of 
Ottawa. He also serves as a 
consultant to the Health Protection 
Branch of Health and Welfare Canada 

and is a member of the Advisory 
Committee on Proprietary and Patent 
Medicines. Dr. Henderson is current 
chairman of the Canadian Medical 
Association Sub-Committee on 
Pharmacotherapy, and lepresents 
both CMA and L'Association des 
médecins de langue française du 
Canada on the Steering Committee 
for the proposed Canadian Drug 
Formulary Service. 
He replaces Ley Smith, president 
of The UpJohn Company of Canada 
who served as interim chairman 
during the formative stages of the 
Board and guided the development of 
the advertising preclearance program. 



..,ú Æ. 



A.V. Raison assumes the position 
of Commissioner of Pharmaceutical 
Advertising. He will be responsible for 
the review of submitted advertising 
according to a Code of Advertising 
Acceptance established by the Board. 
A panel of recognized experts from the 
health disciplines across Canada will 
advise the Commissioner on technical 
questions and arbitrate in cases of 
differing opinion. Raison takes on this 
position following over 15 years as 
editor for the periodicals of the 
Canadian Pharmaceutical 
The program, which became 
effective in January 1977, will initially 
apply only to prescription drug 
advertising, the bulk of which appears 
in trade journal s. Eventually the P AAB 
hopes to extend its jurisdiction to 
over-the-counter drug advertising 
which comprises approximately 25 
percent of drug advertising in journals. 
Since the Canadian Advertising 
Advisory Board along with the Health 
Protection Branch of Health and 
Welfare Canada reviews the 

advertising of over-the-counter 
proprietary medicines, the PAAB will 
not become involved in drug 
advertising that is directed to the 
public via radio, television or popular 
magazines. Its prime aim is to "ensule 
that the content of prescription drug 
advertising to the health professions 
continues to serve the ultimate 
interests of the patient." 
Since the program is not 
mandatory, its success hinges jointly 
on the cooperation of pharmaceutical 
manufacturers to submit proposed 
advertising copy to the Commissioner 
for approval and upon the trade and 
professional media to accept only 
approved advertisements. The final 
responsibility for publication rests with 
the media. The cooperation of the 
health professions and other 
advertisers in referring enquiries and 
complaints to the Commissioner is 
also vital. 
Initial funding of the program was 
provided by the pharmaceutical 
industry, the professions of medicine 
and pharmacy and the trade and 
professional media. Preclearance 
fees for full disclosure, reminder and 
institutional advertisements will be 
charged to advertisers to finance the 
continuing operation of the program. 
Implementation of the program 
will commence with the preclearance 
of an estimated 300 to 400 new journal 
advertisements in both languages, 
annually. After several months, other 
forms of communication will be 
phased in. Preclearance will require a 
maximum of 30 days. 

Better qualified 
would benefit aged 

The quality of life for the aged, in 
institutions and in the home, could be 
improved if those who care for them 
were properly prepared, according to 
the Nova Scotia Association of 
Registered Nurses. "The practice of 
permitting personal care workers to 
perform beyond their preparation is 
unsafe for the aged and represents a 
legal hazard for both employer and 
The warning is contained in a 
position paper "Personnel Required to 

Meet the Needs of the Aged," issued I 
by the Registered Nurses Association: 
of Nova Scotia as part of a continuing , 
program to improve care of the aged in I 
that province. 
The papel, prepaled by a special 
committee appointed by the RNANS 
Executive, observes that, if aged 
persons have health problems which 
necessitate nursing care, whether in 
their own home, or in an institution, 
this care should be given by registerec 
nurses or certified nursing assistants 
While recognizing thatlhere are many 
needs of the aged which can be met b) 
homemakers and/or personal care 
workers, the RNANS is concerned 
about the varying quality of courses te 
prepare this type of personnel and thl 
proliferation of uncoordinated trainin{ 
As a result of these concerns, thl 
Registered Nurses Association 
believes that there is a need for the 
appointment of an individual or a 
group to study the need for 
homemaker services forthe aged, an. 
that there should be collaboration witt 
existing services to develop a 
coordinated plan, organized on a 
regional basis, with regional director
Guidelines for Homemakers for 
the Aged and for Personal Care 
Workers, are included with the 
Position Paper. 

Did you know... 
e 40% of Canadian men and 47<, 
of Canadian women have fitness I 
levels classified as fair or low. 
. Canadian women, with teenage' 
and 20-29 year olds rated the lowes I 
are less fit than men. I 
. Cardiovascular fitness decline
steadily from the age of 8, stabilizin, 
at a very low level, only in late I 
. Over half of the adult Canadial 
population is overweight, and thOSE 
who are fat eat the same number ( 
calories as those of normal weight. I 
. 40% of Canadians watch morE! 
than 15 hours of TV every week. I 
. Only 20% of Canadians enga{;! 
in some form of physical activity SUI 
as walking for pleasure, jogging, 
hiking or other exercise. I 
. Canada's medical care bill 
increased from 2 billion dollars in 19f! 
to more than 7 billion dollars now - 
rise of some 14% per year. 



Mosby texts supplement your instruction 
on various facets of eßective patient care. 


NURSES. By Jessie E. Squire, R.N., B.A., M.Ed. and 
Jean M. Welch, R.N., A.B., M.A., B.S.N.ed. Updated 
to include the most current drug data available, this 
vocational nursing text presents basic information on 
drug administration, source, purpose, route, side effects 
and contraindications. New information includes in- 
travenous therapy, physiology, techniques and nursing 
responsibilities. April, 1977. Approx. 360 pp., S8 illus. 
About $7.30. 

Workbook. By Ruth K. Radcliff, R.N., M.S. and Sheila 
J. Ogden, R.N., B.S. This new workbook can help stu- 
dents learn the necessary math to safely and accurately 
calculate drug dosages. After a pretest to determine each 
student's needs, the text discusses general mathematics 
and all the essentials required for dosage calculation. 
January, 1977. Approx. 224 pp. About $8.35. 

Betty S. Bergersen, R.N., M.S., Ed.D.; in consultation 
with Andres Goth, M.D. Written by a nurse for nurses, 
this leading text outlines current concepts of pharma- 
cology in relation to clinical patient care. It features 
comprehensive, well-organized discussions on drug ac- 
tion, indications, side effects, toxicity, and safe thera- 
peutic dosage range. Two new chapters explain antimi- 
crobial agents and drug effects on sexuality and fetal 
development. 1976, 766 pp., 100 illus. Price, $14.20. 

MACOLOGY. By Sheila A. Ryan, R.N., M.S.N. and 
Bruce D. Clayton, B.S., Phann.D. This practical hand- 
book conveniently summarizes dosage, action, usage, 
possible side effects and interactions of more than 80 
commonly used single-entity drugs. Categorized 
according to their primary action, drugs are arranged 
alphabetically by generic name within each chapter, and 
indexed at the end of the book. January, 1977. 2S2 pp., 
2 illus. Price, $7.30. 


OF BODY FLUIDS. By Shirley R. Burke, B.S.N., 
M.S.N.Ed. This new edition can provide students with a 
sound understanding of general principles of body 
fluids. Examining the relationship of body fluids to 
health and the consequences of typical defects in the 
regulatory system, the text carefully explains cell func- 
tion, extracellular fluid, fluid balance, and acid-base 
balance. A new chapter on blood clotting adds to the 
value of this revision. 1976. 128 pp.. 21 illus. Price, 
LYTES: A Programmed Presentation. By Nonna Jean 
Weldy, R.N., B.S.. M.S. Using a step-by-step ap- 
proach, this practical self- teaching manual presents 
basic principles of normal body fluids and electrolytes, 
common abnormalities, and clinical applications. The 
section on "Electrolyte Imbalance" has been con- 
siderably revised with new material on potassium im- 
balance and new, updated questions. Summaries and 
review questions conclude each chapter. March, 1976. 
130 pp., 24 illus. Price, $5.80. 



plementing the Nursing Process. By Sandra]. Sundeen, 
R.N., M.S.; Gail Wiscarz Stuart, R.N., M.S.; Elizabeth 
DeSalvo Rankin, R.N., M.S.; and Sylvia Parrino 
Cohen, R.N., M.S. Emphasizing the importance of in- 
terpersonal communication, this unique text presents 
psychodynamic and sociological principles relevant to 
the nursing process-the emergence of the self. the help- 
ing relationship, stress, etc. April, 1976. 214 pp., 38 il- 
Ius. Price, $7.90. 




\ , 






The Canadian Nurse February 1977 


Nurse to direct Information Centre 
at Hospital for Sick Children 


A plan now in the finalization stage for 
a Medical InfOfmation Centre for the 
Hospital for Sick Children in Toronto is 
a comprehensive attempt to answer 
many common public and In-hospital 
needs. The new department will 
provide services in an orgamzed way, 
services including triage, poison 
information, channels fÐr medical 
consultation, public advisory 
information, and family physician 
Gail Funger, an experienced 
nursing instructor in the Emergency 
department at HSC, will direct the 
Medical Information Centre in these 
functions. She explains that most of 
these needs have been met in the past 
in a haphazard way, that people 
requiring information quickly had to 
make many calls or visit many 
departments before reaching the 
appropriate source of help. She also 
explains specifically what the services 
offered by the new department will 
mean to those that require them: 
_ Triage - Triage is defined as 
sorting out or setting priorities, and 
refers to the placement of patients 
arriving at the Medical Information 
Centre without an appointment. The 
patient will see an experienced nurse 
at the centre, who will judge whether 
he should be seen in emergency or in 
one of the out-patient clinics. The 
patient and his parents can receive the 
attention and support of the nurse, and 
the delay and anxiety inherent in 
wandering from one department to 
another is avoided. The nurse's 
decision regarding placement will be 
final. No patient she directs to 
emergency will be rerouted back to 
out-patients, causing delay and 
anxiety for the patient and his parents. 
_ Poison Information - 
Establishment of the Medical 
Information Centre at HSC will allow 
calls for poison information to be 
referred directly to specially trained 
nurses (with a medical backup 
consultant) who are prepared to 
handle difficult calls. HSC has 
Canada's largest poison information 
center. The establishment of the 
Medical Information Centre will make 
related information more directly 
available, and will free emergency 
C!:t!:lff tn ,...!:II ro fnr thllCair n!:ltiøntc:: 

. Medical Consulting Services- 
Community doctors requiring 
specialty consults will be able to call 
the Medicallnfonnation Centre. The 
nurses there will be knowledgable in 
fielding such calls to the appropriate 
HSC consultant. 
. Public Advisory Service - 
Many calls to the emergency 
department at HSC are from 
concerned parents who want to know 
from a reliable SOurce how to care fOl 
their sick child. Nurses at the centre 
will be able to answer public enquiries 
or to refer the callers directly to a 
qualified person, avoiding an 
unnecessary and anxiety-provoking 
delay for the parent in receiving 
information. This service will also 
relieve some of the pressure on the 
emergency department and ensure 
follow-up of the patient and parents. 
. Family Physician Feedback- 
Staff in the Centre will ensure that 
contact is made with a patient's family 
physician if he is admitted to HSC from 
the emergency department. 
The Medical Information Centre 
is expected to open this Spring, and 
will be located just inside the Gerrard 
Emergency Entrance. 

UNB announces 
. . 
In nursing program 

The University of New Brunswick has 
announced curriculum changes in its 
three-year baccalaureate program for 
nursing students. The changes 
according to Carolyn Pepler, 
associate professor of nursing and 
curriculum chairman for the faculty of 
nursing. are in line with evolving 
circumstances of modern health care. 
"The first change is an emphasis on 
promoting health as opposed to 
treating illness", she said. Education 
in the health sciences traditionally 
centered on the study of symptoms 
and treatment of known diseases. The 
new curriculum stresses the nurse's 
role in promoting healthy lifestyles and 
preventing illness, she pointed out. 
The second alteration in the 
curriculum is a switch from the study of 

nursing as it relates to locale and/or 
medical specialty to a focus on the 
nursing functions in any setting. This 
means that instead of talking about 
surgical nursing, public health nursing 
or psychiatric nursing, they will talk 
more about the nurse's work of 
comforting, preventing trauma, 
providing therapy, counselling, and so 
forth, says Prof. Pepler. 
The third modification is an 
increased emphasis on the 
problem-solving approach to nursing 
and learning. Since the modem nurse 
deals more with complex situations 
than clearly-eJefined diseases and 
cures, she will have to be flexible and 
innovative in her approach. 
During their fi rst yearthe students 
will be looking at themselves and 
those around them to develop their 
skills in observation and data 
collection. They will attempt to modify 
their own health habits and will be 
studying the theory of change in that 
In their interactions with patients, 
the first year students will concentrate 
on the comforting and protecting 
functions of the nurse, under the new 
The new curriculum will be 
expanded year by year as this year's 
freshmen move through theil 
program. Prof. Pepler pointed out that 
though they will not participate in the 
complete new program, the current 
upper classes in the nursing faculty 
are being exposed to many of the 
underlying concepts and some of the 
In the second year the students 
will expand their nursing to include the 
therapeutic role and the role of the 
health teacher, and will begin to give 
attention to the patient's family, she 
The third year program, building 
on a coursework foundation, will 
involve the students in more teaching 
and counselling. 
In their final year, the nursing 
students will develop the role of the 
nurse as collaborator and advocate 
The collaborative situation is one in 
which the nurse may have the pri mary 
contact with the patient, and works 
with doctors, other health agencies 
and with social agencies for the 
patient's care and welfare 

Health happenings 

More than 100 babies with congenital 
malformations are born each year in 
Canada as a result of their mothers 
developing rubella during the first 
three months of pregnancy. 
Despite the availability of 
effective vaccines, infectious 
diseases are still among the four 
leading causes of hospitalization 
among children. "Parents tend to think 
that communicable diseases are a 
thing of the past and neglect to 
immunize their children," according to 
child health consultant, Shirley Post In 
an article in the December issue of 
Canadian Consumer. Dr. Post points 
out that Canadian children spent a 
total of almost 500.000 days in 
hospital in 1971 (latest available 
figures) as a result of infectious 
diseases. See also, "Communicable 
Diseases and Immunization" by L 
Cranston, The Canadian Nurse, 
January, 1976. 

A paper entitled "Living with the dying: 
use of the technique of participant 
observation," published in the Dec. 
18, 1976 issue of the Canadian 
Medical Association Journal makes 
interesting reading for nurses as well 
as members of the medical 
profession. One interesting sidelight is 
the observation of the effects of 
hospitalization on a well 31-year-old 
M., a medical anthropologist, 
conducted a study to observe the kind 
of care given to patients in the I 
Palliative Care Unit of the Royal 
Victoria Hospital in Montreal. As a I 
pseudopatient in the Palliative Care I 
Unit, he was surprised to find that he I 
began to experience symptoms of 
illness. The study reports, "Once on 
the unit, he identified closely with I 
these sick people and became weaker I 
and more exhausted. He was anorexic i 
and routinely refused to take a I 
shower. He sat exhausted in a chair. I 
He experienced increasing pain, a . 
constant ache in his left leg together I 
with numbness and restless nights I 
during which family members of other 
patients commented sympathetically ; 
on his 'moaning and groaning. M. I 
himself was not aware of this 
nocturnal behavior." . 



NURSING. By lean E. Schweer, R.N., B.S., M.S. and 
Kristine M. Gebbie, R.N., M.N. This exciting text ex- 
plores the concept of creativity as an integral part of 
clinical nursing education. Focusing on the latest 
developments in the field, the book examines a wide 
variety of teaching . pproaches, technological advances, 
and educational communication media. 1976, 224 pp., 3 
illus. Price, $8.35. 

NURSING. By Eleanor W. Treece, R.N., B.A., M.Ed., 
Ph.D. and James W. Treece, Ir.. B.R.E., B.A., M.A. 
The 2nd edition of this successful text discusses every 
step of the research process in clear, non-technical 
language. This revision features updated examples; and 
new discussions on systems analysis, critiquing, opera- 
tional definitions, in addition to other pertinent 
material. January, 1977. Approx. 352 pp., 66 illus. 
Price, $8.35. 


POLITICAL DYNAMICS: Impact on Nurses and Nws- 
ing. By Grace L. Deloughery, R.N., Ph.D. and Kristine 
M. Gebbie, R.N., M.N. This stimulating text presents a 
general overview of the political process, and examines 
specific health care legislation programs and proposals. 
The authors show nurses how to become a force that 
can influence legislation and how to have an equal share 
in health care decisions. 1975, 246 pp. Price, $11.30. 

A Workbook. By Beth C. Vaughan-Wrobel, R.N., M.S. 
and Betty Henderson, R. N., M. N. This first-of-its-kind 
workbook presents the problem-oriented system as a 
theoretical and practical basis for comprehensive health 
care management. The authors provide simple, effective 
guidelines to help nurses collect data, identify patient 
problems, develop plans for nursing care, and evaluate 
progress. 1976, 164 pp., 19 illus. Price, $6.85. 


By Donna Conant Aguilera, R.N., Ph.D., F.A.A.N. 
This informative text provides an overview of current 
concepts and practices in mental health nursing. Con- 
cisely written essays cover such topics as: ego function 
and mental status examination; psychiatric emergen- 
cies; maladaptive behavior; and crisis intervention. 
January, 1977. 172 pp. Price, $5.80. 





M4B 3E5 

\ft J 
\ . 

\ \J " 


-. - 




he Canadian Nurse February 1977 


for bowel management 
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bowel function usually takes place without 
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Importantly, Metamucil is non-habit-form- 
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long term therapy. The dosage can be 
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Available as Metamucil Powder and 
flavoured, effervescent Instant Mix. 

lursing education may be just waking up to the fact that we live in 
n electronic age where students need to become involved in their 
ducation. Children raised on the instantaneous communication 
f television become adults who demand the experience of film 
3ther than being the passive recipients of printed or spoken 

words. The Nursing Education Media Project is Ontario's answer 
to the need to develop greater familiarity with audiovisual aids for 
use in nursing education. Films such as "Don't Cry for David" 
attest to the fact that, although still in its infancy, the organization 
is gaining in confidence and creativity .n 

(letl E.

:ducation in the Electronic Age 

-he Nursing Education Media Project (NEMP) 
; a unique project to educate Ontario nursing 
3achers in the use of audiovisual techniques 
'and to produce and distribute audiovisual 
'naterial. As such, it has attracted the interest 
,f nursing agencies throughout Canada and 
he United States. The product of a decade in 
vhich visual teaching has become as 
Tlportant as the book or the lecture, NEMP 
equires the highest degree of co-operation 
j rom its participants: Ontario's 22 community 
:olleges, the Registered Nurses Association 
)f Ontario, the College of Nurses, and the 
)ntario Educational Communications 

uthority (OECA), the the province's 
lward-winning public broadcasting service. 
yerson Polytechnicallnstitute in Toronto, 
md the University Nursing Programs are 
lctive observers. 
NEMP costs between $45,000 and 
;50,000 a year to operate. The money comes 
rom the agencies taking part. 
Until a few years ago, the creation of such 
1:1 project would have been difficult. Only a 
pandful of nursing schools, mainly in the 
Jigger cities and towns, had access to 
l3.udiOvisual equipment. Nor was there any 
I)verall program of instruction in its use. All of 
that changed when the schools were absorbed 
,nto the community college system, each of 
""hich had a media resource center. 
Community college officials and health 
'science experts assessed the situation and 
foresaw the danger of wasteful duplication in 
,increased audiovisual production. They also 
:realized that there was a lack of production 
'expertise and that material covering many 
Icritical subjects such as obstetrical and 
'neuropsychiatric nursing was frequently 
pnappropriate and/or out-of-date. 
Initially, a series of exploratory meetings 
,were held to determine the feasibility of the 
,media project and map out its structure. 
,Marilynne Seguin, a health science media 
;consultant and former nursing teacher, 
Itravelled throughout Ontario for six months, 
I talkin g to college officials about priorities and 
available facilities and personnel. The result 
was the creation of NEMP, a multi-faceted 
I I cooperative with Ron Keast, of OECA's Media 
Division, as chairman. 

NEMP has four basic objectives: 
. to identify teaching-Ieaming resources for 
nursing education; 
. to produce and distribute instructional 
packages of audiovisual material; 
. to educate nursing teachers in the use of 
audiovisual techniques - videotape, 16 mm 
film slides, editing, production; 
. to distribute quality work done by one 
NEMP member to all other members. 
Of equal importance is the ongoing 
evaluation of materials for college use and the 
identification of subjects for new productions 
and agencies that can assist NEMP. 
NEMP holds seminars and workshops 
throughout the province of Ontario. These are 
designed to use the know-how and facilities of 
OECA and the college and university resource 
staffs, plus guest authorities in many fields, in 
teaching nursing educators about A V 
techniques. For example, workshop delegates 
discuss, design and produce leaming 
packages to be evaluated in the final phase of 
the workshop. Any faculty with a 
communications problem - whether visual or 
print - can call in a member of the project 
resource team to help. 
Although still very much in its infancy, 
NEMP appears to be gaining in confidence 
and creativity. Its agencies have produced 
dozens of works on a wide range of topics, 
from "Care of a patient in a Stryker Frame" to 
"Oral Medication." All productions- 
videotapes or slide tapes with written material 
- are distributed to colleges through OECA. 
The project's most ambitious effort to date 
is "Grieving Due to Loss of Body Image: Don't 
Cry for David," a two-part videotape on the 
rehabilitation of a young athlete whose leg is 
amputated, The tape is accompanied by two 
leaming activity packages that include print 
material, slides and audiotapes. 
Eight pilots, the first of a series of over 20 
presentations on ethics, and a series on law, 
are in the planning stage. According to 
Marilynne Seguin, both the law and the ethics 
series are in response to a demand by nursing 
faculties. The productions are designed to 
illustrate problems rather than to answer all 
questions. Seguin says that the problems find 
resolution through discussions following the 

Manuel Escott 

Another major production - "Charge: 
Incompetence, a Mock Hearing of the 
Discipline Committee of the College of Nurses 
of Ontario" is a 68-minute videotape produced 
at McMaster University in Hamilton, Ontario. It 
enacts a disciplinary hearing based on an 
actual case. 
"This production should be of major 
educational value," says Seguin. "Lawyers tell 
us that nurses tend to treat complaints against 
them lightly and sometimes don't even bother 
to respond to complaint notifications. Then, of 
course, they're shocked to find that their right 
to practice is jeopardized. Often, they have a 
very plausible explanation for their actions but 
have not fully communicated these factors " 
The ethics series attempts to define a 
highly controversial area where a nurse's 
personal morality can conflict with the law or 
other authority. What patient information, for 
example, should remain confidential? What is 
the nature of a nurse's responsibility to herself, 
her patient and the health team on which she 
works? Under which circumstances can she 
refuse to give treatment? The series will also 
deal with many other issues, including 
euthanasia, abortion, truth and lying, and 
organ transplants. 
How effective has NEMP been thus far? 
"It has a great potential, but ifs a little too early 
to assess it fully" says Fred Habermehl, the 
Health Sciences Director of Niagara College, 
Weiland. "Some of the first productions were 
too long, but this is changing." 
''The law and ethics series will have a major 
impact when they're distributed. Nursing 
faculties find it difficult to get a handle on these 
subjects, The films should give us specific 
illustrations of the problems encountered." 
"What we can say are effective, are the 
seminars and wOrkshops. These are 
invaluable in teaching faculties how to use 
visual media properly." 

Manuel Escott has been a journalist for the 
last 24 years. A feature wrtter for the Toronto 
Star for seven years, and foreign 
correspondent with Reuters in the Middle 
East and West Africa, Escott has been a 
freelance wrtter since 1972. 


,,"a'ian urse e.ruary 1'7 

Recent emphasis on family-centered matern ity care is a step in the direction 
of recognizing the father's role in childbirth. Because he has been neglected 
for so long little is known about his feelings during the experience. This 
review of a study of husbands' perceptions of labor and delivery, and their 
reactions to nursing care draws important implications for the prenatal 
re aration of cou les and for their care within the has. ital. 





I "'



'J ì 



Sl e 

Linda Leonard 

Since the advent of modem health care the 
husband-father has received little attention 
during the childbirth phase of the life cycle. 
Although he "plants the seed" and shares 
many experiences with the expectant mother 
during pregnancy. until recently he has been 
excluded from the event. Now, however, it 
seems that most husbands are present for all 
or a portion of the labor, and an increasing 
number are requesting to attend the delivery of 
their child. 
A new emphasis in the hospital on 
"family-centered care" seems to indicate 
official acknowledgement that the husband's 
presence at birth and participation throughout 
his wife's hospitalization is valuable for the 
father and for the new family. Yet despite this 
trend we are still very ill-informed about the 
thoughts and feelings of this family member 
during the bi rth process. If we aspire to provide 
care that is truly family-centered, we must find 
out more about the husband's reactions and 
needs during his involvement in childbirth. 
This article is a summary of the results of a 
study which focused on the reactions of 20 
husband-fathers to labor and delivery. More 
specifically the study probed the husbands' 
thoughts and feelings about the experience, 
their perceptions of their role during labor and 
delivery, and their thoughts about nursing 

a different PERSPECTIVE 
on childbirt h 


The Study 
The study took place in a family-centered 
maternity unit which has approximately 1,100 
births annually. Twenty Caucasian, Canadian, 
or British-born husbands were interviewed 
between 13 and 107 hours after delivery of 
their infant. They were between 22 and 40 
years of age and had some formal education, 
ranging from 8 to 23 years. All attended 
prenatal classes and the labor, eighteen 
attended the birth (one father did not intend to 
be present, the other was unable to attend 
because of fatigue). Seventeen were fathers 
for the first time; three were fathers for the 
second time. All delivenes were per vagina 
and resulted in a healthy newborn of at least 
thirty-seven weeks gestation. 
Interviews with husbands were 
conducted uSing an interview schedule which 





employed rating scales. open-end and 
fixed-alternative questions. No wives were 
present during the interviews. 
The husbands responded 
enthusiastically to being interviewed and 
many began the interview with no prompting 
from the researcher, continuing to talk for 45 to 
90 minutes. 


Events prior to labor and delivery 
All but one of the husbands had decided to 
participate in childbirth by the early third 
trimester of pregnancy and half had made the 
decision before or when pregnancy was 
diagnosed. Only seven fathers expressed 
anxiety and uneasiness about attending labor 
and delivery, and their concems were allayed 


'- to- 






during prenatal classes. 
Most of the husbands wanted to 
participate because they felt their wives 
needed them. Typical comments were: "I 
wasn't going to let her go through that alone" 
and "It's the least I could do for her." Less 
popular reasons for taking part were to share 
the experience together and to have the 
opportunity to see the labor and birth. 

Reactions to labor and delivery 
On a rating scale ranging from +4 (excellent 
experience) to -4 (very bad experience) most 
husbands viewed labor as a slightly positive 
experience (mean+ 1.6) and delivery as a 
moderately positive experience (mean + 
2.26). They described the labor as 
"meaningful," "valuable," "a necessary evil," 
and viewed it as a period of helplessness for 


The Cen. oIen N Uf 5e Fe . ruery 1971 

them and a time of pain for their wives. The 
majority described delivery as a period of 
progress, a time of pain relief, and a time of 
exhilaration tempered with worry about 
possible complications for the baby. 
The fact that labor was rated lower than 
delivery may be partially explained by 
exploring prevailing North American attitudes 
towards pain and the male role in society. The 
relatively passive role of the husband as 
protector and supporter during labor and 
delivery runs counter to the North Amencan 
image which stresses the ability to take 
charge, to be in control and to solve problems. 2 
His role as supporter and protector is 
particularly emphasized during labor because 
analgesics must be used judiciously. This is 
one time when North Americans cannot get 
the immediate relief from pain that they are 
,-!sed to seeking, 3 and for this reason the 
husband may feel especially helpless when he 
cannot see any positive results of his efforts to 
give encouragement and support. Thus, his 
effectiveness will likely influence his view of . 
labor and his self-esteem. Delivery, on the 
other hand, is a period when pain-relief is 
offered, health team members relieve the 
husband of many of his functions and, finally, 
the sight of the emerging baby signifies the 
end of the laboring experience. 
During the first and early second stage of 
labor the husbands tended to direct their 
emotional and intellectual energy almost 
solely towards their wives, noting their 
behavioral responses to pain, pelvic pressure 
and to the husbands' attempts to give support. 
Many tried to look for indicators thattheirwiveE 
were progressing in labor. 
During these early stages, many 
husbands could not remember thinking about 
the baby. One father revealed "There was 
nothing I could do forthe baby. My wife was the 
one who needed me." Those few husbands 
who indicated a high focus on the baby 
admitted that they were concerned about 
whether the baby was getting enough oxygen 
and whether it would be normal. 
In the late second stage of labor the 
husband's focus changed; he was still 
concerned for his wife but was now caught up 
in the fascination of the delivery. Many 
admitted that it was only then that the baby 




became a reality. Several said that some of the 
delivery room procedures, such as 
administration of anesthesia with long needles 
and performance of the episiotomy, made 
them feel "queasy" but that they were able to 
overcome the feeling. The birth of the baby 
brought about a high focus on the infant as well 
as on themselves. The completeness and 
general health of the baby were paramount in 
their thoughts. They needed to know that the 
baby was "all there" and there were no 
anomalies. Reassurance that the color, cry 
and respirations were satisfactory was equally 
important, and was noted by the fathers 
independent of whether the baby was given a 
high or low Apgar rating. Few husbands made 



reference to their wives during this period and 
not one described his wife's reactions to the 
baby at birth. 
The birth appeared to be an infinitely 
personal experience for the majority of the 
men. Durlng the interview, some fathers were 
unable to find the words to describe their 
feeling at the time of the birth but kept 
struggling to do so. Several, as they recounted 
the birth, had tears in their eyes and noted "It 
was the best experience I've had in my life. " A 
minority displayed a flat affect and related the 
birth and their feelings in a monotone. "I didn't 
feel anything," and "It was okay, I guess" are 
quotes from two new fathers. Another 
intimated that he was disappointed in his 







, [' 

emotional reaction to the birth, stating that 
"Some people get off on seeing their child born 
... I didn't:' Similar experiences have been 
described by Greenberg and Morris. 4 

Role During Labor and Delivery 
Most of the husbands saw their role d"uring 
labor as that of providing support, 
encouragement and physical care to their 
wives. For this reason many chose not to leave 
their wives during the experience, even for rest 
or nourishment. Of those who did take a break, 
some expressed guilt at seeking this relief 
when theirwives were unable to do so. Others 
noted that it was worse to be separated from 
their wives than to be with them. 








Most felt that they had helped their wives 
a great deal during labor and attnbuted their 
success to the prenatal class instruction and to 
the labor-room nurses At the same time they 
needed to confirm their slJccess with their 
wives. Those who had not discussed the 
success of their role with their wives tended to 
believe that they were of very little help, 
There were periods during the labor in 
which the husbands were not able to help their 
wives. They had difficulty coping with their 
wives' pain and loss of control during 
transition. Some said that they lost control and 
that this was precipitated by their wives' 
reaction to the contractions, the diagnosis of 
fetal distress, and/or extreme fatigue of the 

In a Question concerning the father's right 
to attend the bi rth of his child, mostfelt strongly 
that it was their right. A smaller group believed 
that it was not their right but said they would 
still like to be present. The husbands 
spontaneously noted that if their presence in 
any way jeopardized the health of their wives 
or babies, or interfered with the health team 
members' performance, they would accept the 
decision not to be present at delivery. 
Many health team members have 
expressed concern about 
husband-attendance during the birth of a sick 
or malformed baby, In response to a 
hypothetical question, nineteen fathers said 
they would prefer to be with their wives dunng 
the birth of a potentially unhealthy baby. They 
felt that they did not want their wives to be with 
strangers during this time and that they would 
be able to share their grief together. 

Perceptions of Nursing Care 
When asked what aspects of nursing care 
were helpful or not helpful to their wives and 
themselves during labor and delivery, the 
husbands focused on five categories: 
. the attitudes and responses of the nurses 
. inclusion of the husband in the experience 
. assessment and explanation of labor 
. contact with the nurse other than for 
. physical care of the woman in labor. 
The nurses' attitudes and responses 
which were identified as helpful were 
"friendly." "kind," "cheerful," "thoughtful," and 
"interested." Many husbands obser\1sd that 
the nurses cared about their wives and that the 
nurses' attitudes were significant in 
establishing their own confidence. Their 
perceptiveness and vulnerability during labor 
is illustrated by one husband's reaction to 
some nurses laughing outside the labor room: 
"I can appreciate that you have to laugh in 
a place like this but when they didn't 
stop... I kept looking at my wife in pain and 
thought 'my God, what can they find so 
Most of the husbands did not expect 
the nurses to go out of their way to include 
them in the bi rth experience. but when they did 
it seemed to leave a very positive impression. 
Helpful gestures of the nurses, such as 

bringing coffee or juice to the husband while he 
was at his wife's bedside and "spelling him off" 
for short rest periods, were seen as indicators 
that he was accepted by nursing staff. 
Husbands also appreciated the nurses' 
d demonstrations of progress 
made by thelrwlve
. Several objected to being 
asked to leave dunng pelvic examinations an 
observation also made by Jordan,s while'a 
small number welcomed the break away from 
their laboring spouses. 
The ass
ssment of the mother and baby, 
and explanation of the results was a perceived 
weakness in nursing care. Husbands felt there 
was a need for more frequent and accurate 
assessment, particularly during the transition 
phase and the second stage of labor. Several 
husbands echoed the sentiments and 
displeasure of these three men: "I knew that 
she was going fast. I had to go out and get the 
nurses a few times... they could have 
anticipated how quickly she was progressing'" 
"There was panic at the end;" and '" could' 
have ended up delivering the kid myself." 
Husbands apparently needed to have 
human contact during this emotional and 
fatiguing experience and welcomed contact 
with nurses other than for assessment 
purposes. One husband described a nurse as 
"She'd say that she would bring such and 
such in 15 or 20 minutes and then she 
would. You knew that you only had to go 
for 15 minutes, not forever, before she'd 
come back." 
Many fathers said they knew the 
nurse was outside the labor room and that 
all they had to do was ask her to come. 
However, they were reluctant to summon her 
e, as one !ather stated, "She probably 
couldn t do anything anyway." Several fathers 
indicated that they saw the nurse as much as 
they wanted and appreciated being left "to do 
our own thing." 
A large majority of the husbands praised 
the care given to their wives in the form of 
back rubs, assistance with position and 
breathing, and provision of analgesic 
dications and clean laundry. Problems in 
this aspect of nursing care centered around 
acquiring satisfactory pain relief for their 

Implications for Nursing 
If nursing hopes to promote optimal family 


Linda Leonard (B.Sc.N. and M.Sc.N., 
University of British Columbia) has worked in 
 and delivery rooms and in psychiatry. 
She IS now teaching in the Baccalaureate and 
 programs at the University of British 
Columbia School of Nursing. 

ioning, we must take responsibility for 
helping the husband-father to achieve 
satisfaction from and feel effective in his role in 

he. birth process. The results of this study 
Indicate some specific ways that the nurse can 
achieve this goal, although one must be 
careful in making generalizations from such a 
small and specific study. 
The nurse involved in teaching prenatal 
classes should be aware that her attitude 
regarding husband-participation in labor and 

er confidence in the expectant father is highly 
Influential. The teacher's confidence and 
reassurance seems to benefit those men who 

re undecided and uneasy about participating 
In labor and delivery. Husbands asked that 
more emphasis be placed on helping both 
parents cope with the pain of labor; many felt 
betrayed by their instructor, who left them with 
the impression that labor is uncomfortable but 
not necessarily painful. Perhaps a discussion 
regarding attitudes to pam as well as feelings 
and behaviors elicited by seeing someone 
else in pain would benefit husbands. It might 
also be appropriate to coach husbands in how 
to recognize behaviors that their wives 
indicate are emotionally and physically 
The nurse caring for the couple in labor 
and delivery can do a great deal to make the 
experience a positive and satisfying one for 
the husband. First, she must recognize that 
bands are highly sensitive during this 
penod to the nurse's attitudes and responses 
to the couple. The nurse's expressions of 
warmth and caring, and her efforts to include 
the husband convey acceptance to him and 
foster his ability to help his wife function. 
At the beginning and as labor progresses, 
it is important for the nurse to assess the 
specific role the father hopes to play in labor 
and delivery, as well as the kind and amount of 
contact the couple wants with the nurse. She 
must be aware that the husband is more likely 
to need her presence, even if he doesn't 
specifically request it, during the active phase 
of labor, during periods of ineffectual progress, 
and when he is tired. Permitting the husband to 
stay with his wife as much as the couple 
ires, e.g., during pelvic examinations. and 
being available to "spell the husband off' for 
t-breaks from time to time also help to 
relieve the stress of the situation. To maintain 

he husband's confidence the nurse may also 
Identify the ways in which the husband is being 
supportive of his wife. Although 
communicating to the couple regarding the 
progress of labor is a fundamental principle of 
care, results of the study indicate that it needs 
to be re-emphasized. The health status of all 

\-.-- ----- 

infants born, independent of the Apgar rating 
should be interpreted to couples. ' 
During the postpartum period it is 
essential that those who care for the family be 
alert to husband-wife-infant interaction and to 
their desire to communicate their reactions 
and feelings. 6 .The nurse should encourage 
ples to review the labor and delivery, and 
their performance, as soon after delivery as 
possible, and to verbalize questions and 
s about the experience. This may be 
done with the nurse on an individual basis or 
she may bring together a small group of new 
parents to discuss their common experience. 
In our recent emphasis on 
"family-centered care" we have begun to 
accept the father's role in childbirth. We still 
have a long way to go, however, to fully 
 his needs and perceptions during 
this expenence. This study of fathers' 
perceptions of labor and delivery, while taken 
from a small sample, offers nurses some 
insight into how they can help the expectant 
and new father. Whatever specific actions the 
nurse takes to convey her acceptance, care 
and support to the expectant father it is clear 
that this neglected family member n
eds to be 
given much more attention to make the 
experience of childbirth as rewarding and 
positive as it can be. oIj, 

1 Leonard. Linda G. "Husband-Father's 
Perception of Labour and Delivery," MSN Thesis, 
U.B.C. School of Nursing, April 1975. 
2 Benson, Leonard. Fatherhood: A sociological 
perspective. New York: Random House. 1968. 
3 Zborowski, Mark. "Cultural components in I 
response to pain" in A Sociological Framework fOI 
PatIent Care, ed. Jeanette R. Folta and Edith S. 
Deck. New York, Wiley, 1966. p. 259. 
4 Greenberg, Martin and Morris, Norman. 
"Engrossment: The Newborn's Impact Upon the 
Father," American Journal of Orthopsychiatry. 
44:4:521 July 1974. 
5 Jordan, A. Doreen. "Evaluation of a 
Family-Centred Maternity Care Hospital Program, 
Part I: Introduction. Design, Testing," JOGN 
Nursing. 2:1 :17, January, February 1973. 
6 Rising, Sharon S. "The Fourth Stage of 
Labour: Family Integration," American Journal of 
Nursing. 74:5:870, May 1974. 

Note: a bibliography is available on request from 
CNA Library SeNices. 


Benoxyl:Lotion 200k 
proven effective 
in treatment of cutaneous ulcers 





Left : ulcer of right greater trochanter, 14 cm in diameter, with 
undercutting of superior border to 3 cm. Right: full healing after 
8 months therapy with benzoyl peroxide. 


! I 

Benzoyl peroxide, a powerful organic 
oxidizing agent, was applied topically 
according to a carefully developed 
technique to cutaneous ulcers of 
different types. The healing time was 
shortened greatly by the rapid 
development of healthy granulation 
tissue and the quick ingrowth of 


Exceptionally large pressure ulcers 
with deep cavities, undercut edges 
and sinus tracts were successfully 
treated, as were stasis ulcers of long 
'duration resistant to all other therapy. 
There were only 13 
treatrrtent failures 
among the 133 
cases. 1 


:1 I 


. I 
. I 

Available only from Stiefel 

Of(.: - 


.K fTlEF#J 
L{, flON U S.P. 

Montreal, Canada H4R 1 E1 

.1 . 

ReIerenc:e: 1 Pace, WE: Treatment 01 CUlllneoua ulcers willi benzoyl peroucle. Can IIfIed. 
Assoc J 115:1101. 1976 

Years ago, most ostomates went home with a so-called "permanent" appliance. The 
disposables available then were mainly for post-op use. Now, though, there's a 
family of simple, convenient disposables your patient can wear home with confi- 
dence. These Hollister disposables offer all you'd expect of "post-op" appliances: 
lightness, one-piece construction, ease of handling. Yet they're strong-made of a 
tough multi-layered film that holds back odor more than 200 times as effectively as 
common polyethylene plastic. Thousands of ostomates who were started with 
Hollister disposables in the hospital have gone right on using them as their full-time 
appliances. Your patients can, too. 





.,. -.- 









Send her home confident. 
An odor-barrier Karaya Seal stoma 
bag will provide 
skin protection, 0= 
security, and 
simple self-care 
until her 
colostomy is 
regulated. And 
Hollister's ver- 
satile, mess- 
Irrigator Kit offers an easy way to 
establish her irrigating routine. 

Send him home secure. 
Specify a Karaya Seal Drainable- 
the disposable 
that provides 
effective skin 
without elaborate 
skin preparation. 
It fits snugly 
around the stoma, 
sealing off skin 
from potentially excoriating 
discharge, yet is easy to put 
on, easy to empty. and easy 
to dispose of. 

Write on professional or hospital letterhead. 

There's a Hollisier Producllo slmpll/y 
every sloma-care lask 






Spare her the faceplate-cement- 
solvent routine. 
Urostomy Bag 
appliances by 
Hollister. These 
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convenient drain 
valve for ambula- 
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snap-on tube for 
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and do away with 
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most "permanent" appliances. 


A Iltl\J 1 
.L.L .L .L .L.L..J.L \l .L Janet B. Berezowsky 

The acutely psychotic patient poses a special threat 
within the general hospital setting because staff is 
frequently unaccustomed to dealing with such behavior. 
Management of these patients can be effectively 
achieved by using appropriate measures to reduce the 
anxiety of the patient, staff, other patients and visitors. 
Here, Janet Berezowsky outlines the nursing 
interventions necessary to deal with the acutely 
psychotic patient and the steps that can be taken to 
reduce the anxiety of those around him. 

Acutely psychotic patients are being seen more and more often In 
the general hospital setting. Yet frequently the staff who must cope 
with them have had little or no experience in dealing with this type of 
patient. The bizarre and often threatening behavior of the psychotic 
can be very frightening both to staff and to other patients; its 
occurrence In the hospital presents major management problems. 
The central problem in coping with the acutely psychotic patient 
is anxiety - anxiety of the patient, anxiety of the staff and anxiety of 
other patients and visitors. If the anxiety of the patient is dealt with by 
using appropriate medications and nursing interventions, psychotic 
behavior can be controlled within 24 hours of admission, and 
symptoms can be greatly reduced within a week. The anxiety of staff, 
visitors and other patients, while it may seem less immediate than 
that of the acutely psychotic patient, is still an important factor. 
Reducing the anxiety of those surrounding the patient minimizes the 
threat not only to those involved but to the psychotic patient himself. 


The Canedlan Nurse February 1977 


The Patient 
The patient experiencing a psychotic episode, brought to 
hospital frequently under pressure of family or police, is cer'tainly 
expressing anxiety. He is frequently hallucinating and preoccupied 
with unreasonable and bizarre fears. He may be physically 
aggressive or acutely suicidal. The psychotic patient has lost 
control, control of his ability to relate effectively to the demands of his 
reality situation, control even of the decision to seek medical help. 
He will often attempt to assume control in the only way he can - to 
leave the hospital. 
Because the situation presents itself in such an immediate and 
extreme manner, nursing interventions must be guided by certain 
.Explanation of intent: The first and most essential therapeutic 
maneuver is to take control for the patient. It is important that the 
patient be provided with an explanation of his experience: that is be 
informed that he is having difficulty controlling his behavior and his 
thoughts, and that for the present this responsibility will be assumed 
by the treatment team. A brief explanation of the treatment plan 
should be given, his cooperation should be requested and the staff 
should proceed to take control. Staff must take care to do this in a 
caring rather than a punitive fashion since the patient is particularly 
sensitive to punitive approaches at this time and is easily provoked 
to "fight or flight." 
Although the plan to take control is usually conveyed to the 
patient by the treatment team in the emergency room, when the 
patient is transferred to an in-patient unit it is desirable for at least 
one member of the assessment staff to accompany the patient and 
to relate the plan to unit staff in the patient's presence. The intent of 
hospital staff will be reinforced if the assessment team remains in the 
unit initially and assists unit staff to assume control by administering 
medications, removing street clothing and, if necessary, 
re-explaining to the patient the plan originally made in emergency. 

. Administration of medication: The most commonly used 
medications are anti psychotics, but antidepressants and 
barbiturates may be added to this regime. The initial medication 
should be given I.M. or LV. in a dosage large enough to quickly 
sedate the patient. The actual dosage will depend on the patient's 
age, body weight, the intensity of psychotic symptoms, and the 
previous use of such medications, but nurses should be familiar with 
appropriate dosages. Liquid medication may be more acceptable to 
the patient, but pills should not be considered since there is little 
assurance that the patient will actually swallow them. 
If a choice of liquid or I.M. medication is to be offered, both 
should be prepared so that, should the liquid be refused, staff can 
immediately proceed to give the medication intramuscularly. 
Medication should be presented to the patient in the privacy of his 
room, (or cubicle if the patient is still in emergency), and staff should 
block the patient's most likely routes of escape by standing between 
him and possible exits. The patient should be informed of the plan 
and requested to cooperate. 
It is likely, however, that the patient will attempt to resist the staff 
at this early stage of treatment. In this event, staff should be 
prepared to use force in administering medication. All those involved 




should remove glasses, watches and rings which could be broken or 
damaged and might inflict injury to the patient in a struggle. The staff 
member who has the best relationship with the patient should be in 
charge, to speak to the patient. give direction to the staff and 
administer the medication. The presence of at least three to six staff 
members is necessary for safety, and very often this show of force is 
sufficientto reduce the likelihood of a struggle. If only one or two staff 
members attempt to medicate the patient, he will likely struggle and 
staff and patient may be injured. More than six staff members 
intensify the patient's anxiety and may precipitate a struggle. 
To administer medication, staff members should move in close 
to the patient. Often when patients realize that argument or 
discussion will not alter the intent of the staff, they will accept liquid 
medication without struggle. At least one memberof the staff should 
remain with the patient until the medication takes effect. 
Such behavior of the staff clearly conveys that they are in 
control and, when this procedure is used, patients rarely resist after 
the first three or four doses of medication. In any event the above 
approach should be used until the patient willingly accepts 
Regular administration of medication every 4 hours for the first 
48-72 hours is usually essential. Since the antipsychotic effect of the 
phenothiazines takes about five days to develop and the 
mood-elevating effect of most antidepressants takes even longer, 
the sedative effect of these medications will be the initial means of 
control. The patient should be drowsy but care must be taken to be 
sure his level of consciousness has not been severely depressed 
and that his vital signs following assisted mild exercise are 
satisfactory. If the patient's blood pressure is very low (less than 
80/50) it is preferable to withhold medication for an hour or so and do 
passive exercises with him, dangling his legs overthe side of the bed 
and assisting him to walk about in his room. In determining the safety 
of administering the next dose of medication, the nurse should be 
certain that the patient can be roused, that he responds to pain and 
that his hand grips are moderately firm. An increase in psychotic 
symptoms, particularly visual hallucinations, probably indicates 
toxicity. Very close observation of the patient is essential at this 
stage of treatment. 
Once the patient requires waking in order to administer each 
dose of medication through the night, it is usually safe to give the 
same total amount of medication in aq.i.d. regime. Within 5to 7 days 
the dosage can usually be reduced. 
. Removal of street clothing: To tell a patient that we want him to 
remain in hospital and allow him to keep his street clothing gives him 
a very ambiguous message. Once the initial dose of medication has 
begun to take effect, the patient should be requested and assisted to 
change into hospital pyjamas. Asking him to disrobe before being 
sedated frequently increases his anxiety because he may fear a 
sexual assault. 
All street clothing should be taken from the patient and locked, 
and visitors should be supervised to be certain they are not bringing 
clothing to the unit for him. If the patient is kept in hospital pyjamas he 
will be easily identified if he attempts to leave the hospital and he can 
be returned without necessarily involving public or police assistance. 

. Dajfy nursing care: Once the patient's immediate needs have 
been met the emphasis of nursing care shifts to his daily physical 
and emotional needs while he is in hospital. 
In treating the acutely psychotic patient it is essential that 
adequate fluid intake be maintained (1500-2000 ml/24 hr). This can 
usually be accomplished by offering oral fluids regularly, as often as 
q1 h. The patient should not be left to make the decision whether or 
not to drink, but should be informed that he will be assisted to drink. 
The nurse should position him, put the fluid to his mouth and direct 
him to swallow. An elevated temperature or symptoms oftoxicity are 
common signs of inadequate hydration. The consistent and caring 
attitude of the staff in meeting this basic need will facilitate the 
development of a trusting relationship. 
Acutely psychotic patients tend to prefer water, juices, and 
sImple sweet foods which require a minimum of chewing or 
preparation before eating. Because of their reduced activity, 
together with the side effects of medication and an erratic eating 
pattem prior to admission, psychotic patients frequently develop 
constipation. They should be questioned several times a day, 
assisted to the toilet regularly, and provided with laxatives p.r.n. until 
they are able to resume activity and diet pattems which will prevent 
such complications. 
The acutely psychotic patient should be given a low bed or 
mattress on the floor to reduce the possibility of injury due to falls. 
Regular exercise periods, where the patient is assisted in passive 
exercises by one or two staff members, should be arranged to 
prevent respiratory and circulatory complications (hypostatic 
pneumonia and hypovolemic shock). The patient's vital signs 
(temperature, pulse, respiration and blood pressure) should be 
monitored before each dose of medication. Because the 
anticholinergic effect of medications increases the risk of damage to 
mucous membranes, regular mouth care is essential. Regular 
bathing, turning and positioning, and massaging of pressure areas is 
also very important to prevent breakdown of the skin. Smoking 
should be controlled and supervised. The patient should be informed 
prior to each nursing intervention, so that he does not perceive it as 
an assault. All of these attentions, which form the basis of good 
nursing care, help to convey to the patientthatthe staff is concerned 
about him and is looking after his needs. This knowledge that the 
staff is in control serves to reduce the patient's anxiety and increases 
his feelings of safety and security. 
The patient should be provided with a quiet, restful environment 
free of distracting noises, activity and objects. A locked room is a 
poor solution unless staff are with the patient continuously; the 
feeling of being abandoned will only increase the patient's anxiety. In 
an unlocked room, frequent regular visits to provide reality 
orientation and basic physical care soon allay the patient's anxiety 
and enable him to cooperate with the treatment plan. Reality 
orientation should include calling him by name and telling him your 
. !"lame, that you are a nurse, that he is in hospital, explaining your 
Immediate nursing intervention, telling him the date and time of day 
and any other significant information such as doctor visits or family 
visits. Expression of psychotic ideas should be responded to with 
kindness. It is important to acknowledge that you understand the 
ideas or feelings which he expresses and to describe reality clearly 

and simply. Discussion and arguments serve only to strengthen the 
patient's psychotic ideas. A limited number of consistent staff should 
work with the patient in this phase of treatment in orderto keep reality 
relatively simple for him, and to develop a therapeutic relationship 
which is essential for a successful outcome in the convalescent 
Anxiety Surrounding the Patient 
Particularly when the acutely psychotic patient is first brought to 
hospital, his behavior is likely to cause anxiety in those around him 
In order to deal effectively with the patient and create a therapeutic 
environment, it is essential that this anxiety be minimized 
Anxiety of the nursing staff can be greatly reduced by careful 
application of the approaches described above and by effective 
teamwork. The nurses who care for acutely psychotic patients 
frequently require the assistance of their colleagues to provide 
adequate, safe nursing care and to ensure even temporary relief 
from this demanding regime. New staff should never be designated 
to care for such acutely disturbed patients until they have had an 
opportunity to observe and assist in the regime. Detailed teaching 
and supervision should be provided until staff are comfortable and 
able to make safe judgments and provide skilled care to these 
Physician-nurse teamwork centers around two points: the 
physician's reinforcement of the treatment plan to the patient, and 
the provision of adequate medication orders to prevent further 
uncontrollable psychotic behavior. The physician who is defining the 
treatment plan should present it to the patient initially, and reinforce 
it frequently. This may be done verbally or by actually assisting with 
specific interventions such as the administration of medication or 
The availability of sufficient immediate assistance to deal with 
possible crises is essential. Crisis situations should occur 
infrequently once this regime has been established. When they do 
they are usually due to failure to obtain adequate medication orders, 
failure to use the medication ordered, or failure to provide very close 
supervision until continual control is established. 
Anxiety of other patients, relatives and visitors can be reduced 
by giving them simple. factual information about the patient and the 
means by which the staff are maintaining control, and by ensuring 
that they are not left alone with the acutely psychotic patient. Fear of 
unpredictable, uncontrolled assaultive behavior is intense for the 
uninformed single observer. If a struggle is anticipated, it is 
advisable for nursing staff to remove other patients and visitors from 
the area and for at least one staff member to stay with the patients 
who have been removed. Simple. factual explanations should be 
provided in a calm, concerned manner. 
Family members should be encouraged to maintain contact 
with the patient during the acute phase. Their visits should be short, 
supervised and facilitated by nursing staff. Explanations of the 
treatment plan as it proceeds should be provided regularly for family 
members and for other patients on the unit. This helps greatly in 
maintaining a therapeutic milieu for other patients in the setting. 
The suggestions above for dealing with acutely psychotic 
patients center around the problem of anxiety. They are intended to 
help staff in a general hospital who are frequently unaccustomed to 
dealing with acutely psychotic behavior but who are being 
confronted with this type of patient more and more often in their daily 
routines. In order to deal appropriately with what often threatens to 
become a crisis situation, nurses can develop the skills to deal 
appropriately with these patients and to reduce their anxiety and 
the anxiety of those around them. 4.0 

Janet B. Bere
wsky (R.N., B.S.N., B.A., University of 
Saskatchewan) was head nurse of the psychiatric unit at the Royal 
Alexandra Hospital, Edmonton, Alberta at the time that she wrote 
"Nursing the Acutely PsychotIc Patient." She had previously 
worked as a staff nurse, head nurse and clinical instructor in psy- 
chiatry. Since then she has returned to school and is working 
towards her M. Sc. in Family Studies at the University of Alberta. 


fo cf!{alle 
a {8ome6acll 



.. .r,:\ .


L. Patricia R. McMeekan 
There are many clichés in nursing by which the profession 
sells itself short. How many times have you heard the 
. "At least nurses will always be needed." 
. "Once a nurse, always a nurse." 
. "A nurse is also a teacher." 
Fallacy number four is one that has only recently 
appeared on the scene. It goes like this : "To teach nu rsing is a 
nice way to get back into nursing:' The implications of this 
statement are cause for alarm and concern. 
In the institution where I work there are many part-time 
clinical teachers. In advertising for these positions the 
necessity for recent active nursing experience is always 
stipulated. In spite of this, almost one third of the telephone 
enquiries I have received about these jobs in the past two 
years have begun along lines like this: 
Enquirer: Hello, I am interested in your advertisement for 
part-time (or even fu/!-time) teachers. I have been out of 
nursing for 5 (10 or 15) years. and /feel that this would be a 
nice way to get back into it. 
Recipient: What have you been doing during the last five years? 
Enquirer: Oh, bringing up my family, which is a good experience 
with which to help students, don't you think? 
Redpient: We require the teachers, especially the clinical ones, 
to have recent experience. What type of nursing was your 
Enquirer: I worked in a doctor's office (or Obstetrics, or Public 
Health, or something somewhat specialized). I graduated 
12 years ago from the 'good old three year program.' Surely 
you are not saying that all this experience is of no value. 
This type of conversation is a composite of many, but 
the theme has been very similar... that to have nu rsed at all is 
sufficient preparation for teaching it. 
I suggest that nurses who are contemplating re-entry 
into the profession by the "back door" of teaching, would do 
well to ask themselves the following questions: 
1 Assuming that the majority of nursing students are 
between 17 and 20 years of age, how do I regard young 
people in this age range ... as children, or as 'becoming 
2 How do I feel about students as a group ... are they 
basically trustworthy or untrustworthy? At what point on the 
growth and development continuum do I expect to find them? 
3 What sort of person am I ... do I need direction and 
structure, or am I self-directed and flexible? 
4 Am I willing (and able) to spend a lot of home and/or 
family time on the preparation, study, marking of papers and 
the myriad of other tasks that are part of teaching? 
5 What is my concept of teaching ... standing on a dais in 
front of a class handing out information or as a nurse watching 
a student carry out a procedure? (In a cynical vein, many 
perceive the latter as the teacher standing with arms folded). 
6 How do I perceive the learner ... as passive and 
receiving, or active, participative and challenging? 
7 Should a learner evaluate himself, or should I be telling 
8 Could a learner evaluate me... could I accept it if it were 
9 Should the learner make mistakes, or does that mean 
that my teaching was poor or unsuccessful? 
10 How well do I remember the principles of teaching and 
learning ... or did I ever learn them? 

In Reality Shock. author Marlene Kramer identifies a 
group of people found in nursing schools. These are the 
ILateral Arabasquers who have achieved very well as nursing 
tstudents but are frustrated as registered nurses. feeling that 
they are unable to carry out the level of care which they have 
I been taught. So, they become nursing teachers!!! 
Occasionally a registered nurse with considerable expertise 
, in recent nursing care feels that she would like to share this with 
nursing students. Undoubtedly, a person with such a background 
could provide excellent learning experiences for students. 
However. the teaching of nursing requires more than the 
ability to demonstrate care. The teacher, in any field, should 
be able to cope with self-direction in the use of her time. 
Nurses have a particular problem in transferring from the 
traditionally highly structured service setting to an 
environment of considerable flexibility. In a nursing school, 
even small items such as coffee breaks (except while in the 
clinical area) are highiy individual and are planned by the 
teacher herself. Other than scheduled classes and interviews, 
the timing of the teacher-work is up to the teacher. If the 
would-be teacher is a dependent person, to an extent, and 
prefers a fair degree of predictability in the day's work, then 
he/she should re-examine his/her goals. 
If these goals include teaching the students all the things 
which you were not able to do as a registered nurse, then the 
students will soon get the message that nursing education is 
an exercise in futility. They will learn little about the 
combination of idealism and reality that is essential for 
adequate performance as a professional registered nurse. 
If your goals include conveying to the students how 
unfortunate they are not to have had a three-year program in a 
hospital school... think again! Forty years ago nurses in 
Canada endorsed twe facts: 
. Education should not be paid for with service. 
. Education should be conducted mainly in educational 
Today, finally, this dream has become reality and yet 
some of us continue to behave as though the concept were a 
new one. The two-year program was justified by experiment 
starting in 1948, and has been functioning increasingly 
I effectively since 1960, producing 'beginning' graduates, not 
'finished' ones. Their potential, in many instances untapped, is 
many times greater than that of the so-called 'better' 
three-year programs. It is a well-known fact that persistent 
enforcement of behavioral expectations eventually produces 
that behavior. The graduates of today are being "boxed into" 
an inferior position by the unproved expectatiorJ that they will 
be poor practitioners. Registered nurses in the service areas 
are not alone in conveying these sentiments: as teachers, we 
convey them too, indirectly perhaps but the students hear 
, such statements as: "If only I had more time to teach you 
, properly" of "Of course, spending so much time on arts 
courses lessens your time for nursing:' and so on. 
If you really would like to teach nursing, give serious 
thought to your philosophy of nursing education. Do you want 
a nurse who knows justthat ... or do you want a nurse who has 
the kind of broad knowledge base that enables her to 
understand other people's problems as well as to solve her 
own personal and professional problems. 
I am not condemning the 'old' programs: I feel that, to be 
proud of one's training and to be defensive in the face of 
change are two different things. I am very proud ofthe training 
I that I received (and it was training !) butthat does not mean that 
I must blind myself to the possibility that anything better could 
be developed. ... 

The author of this month's Frankly Speaking, Patricia 
McMeekan, B.Sc., M.Ed., is assistant director of 
nursing at Sheridan College School of Nursing in 
Mississauga, Ontario. She bases these observations 
on her experience in nursing education in that province 
and also on the assumption that "clinical teaching, 
especially in the diploma nursing program, occurs 
mainly in the hospital setting." 



160 MAIN ST. S. 

441 1 /2 GEORGE ST. N. 

Frankly Speaking is intended as a forum for nurses 
who want to speak out on issues that may influence 
the future of nursing practice, research, 
administration or education. Guest columnists 
from time to time will be members of the Board of 
Directors of your national professional association. 
If you have an opinion or concern that you 
would like to share with your fellow nurses, why not 
write to us. This is your chance to get involved, to 
participate in shaping the destiny of your 




MaryDean Samanskl 

Little people who could not ask for a 
cookie, a drink, or their shoes... who 
could not say "hello," "I'm cold," or 
"please help me" ... who could not ask for 
a favorite record, toy or song. Worst of all, 
perhaps, who could not make the adults 
around them realize how much they really 
did know . 
These were the non-verbal, hearing, 
developmentally handicapped children at 
Durham Centre in Whitby, Ontario, just a 
little more than a year ago. As staff 
members caring for them, we had no 
guidelines, no literature, no adviser, only 
a book on sign language and the strong 
desire to help these little people find a way 
to communicate with their counsellors, 
teachers, parents and peers. 
It was the Speech Pathologist at the 
Centre, Karen Portigal, who conceived 
the idea of teaching sign language 
through the medium of songs and music. I 
was a Registered Nurse also employed at 
the Centre as Recreation and Crafts 
Instructor, and Karen's enthusiastic 
collaborator. When she left, I continued to 



../ - 


carry out the program with the assistance 
of the faithful volunteers who had been 
involved in the music program from the 
beginning. On most days, the child-staff 
ratio was four to one. 
Our original aims were to teach 
signs, stimulate language and, where 
possible. develop speech. We wanted the 
children to leam to identify and ask for 
necessities, to express some feelings and 
to be happy with their accomplishments. 
The program had only just begun when 
we realized that we were also motivating 
the children to want to communicate and 
to use signs and/or speech. The first step 
was to give a sign and verbal clue that 
represented a concrete object, which the 
children would imitate. The children 
progressed from this to the spontaneous 
use of signs. Next came the ability to 
vocalize with meaningful sounds and 
It did not occur to us when we began 
that we would open up a new world to 
these children - a world in which they 
could learn to think, make decisions, feel 
worthwhile and even entertain 
themselves. We see children with poor 
self-concepts begin to develop an 

Total communiúation 
for non-v0rbal 
h0arin9 úhildr0n 

improved image through "I" and "me" 
songs, dancing, signing in the mirror and 
a lot of laughing and hugging. When 
babies start to talk they babble, gurgle. 
coo and are smilingly encouraged by 
Mom and Dad. In our daily classes we 
laugh a lot and use every opportunity to 
encourage a child to participate at his own 
level. For example, a sneeze is a good 
opportunity to say "atchoo" and use two 
vowel sounds. If a child cannot say 
"atchoo," he can at least laugh at 
everyone who does. 
Each 45-minute session begins with 
a lively, sociable "welcome" song that 
encourages us to be comfortable with one 
another. We greet our friends with signs 
and words like, "Hello, how are you?" 
"I'm just fine. how are you?" "Sit down, 
have a seat, good to see you here with 
me." etc. In order to avoid confusion, we 
sign only key words. I then ask the 
children what record they want to hear 
and someone will sign drum. A "noise" 
song opens with a booming kettle drum, 
inviting us to beat the drum and say 
"boom, boom, boom." It tells us to make 
the "greatest noises in the whole world 
that come from you and me" by 
clapping, stomping, snapping, 
coughing, kissing, laughing and 
whistling. Shouting "wahoo" singing "0" 
and a surprise, for example a request to 
be quiet, are all included. This record 
teaches us to sign, vocalize, sing, find me, 
find you and have fun, all at the same 
The choice of props and songs is 
limited only by the imagination of the 
leader. Almost any favorite song, for 


example, can be used to teach the signs 
for common objects such as food, clothing 
and animals. I am particularly fond of Paul 
Nordoff's songs because they are 
especially written for developmentally 
handicapped children. These songs, 
along with the props we use, encourage 
spontaneity and creative thinking in the 
children. One of the props we use is a 
baby puppet. Our baby cries and I cry: 
baby sleeps, I sleep, baby says 
"mama"' and each child attempts to say 
I "mama."' Some succeed, some do not. A 
popular addition to our visual aid 
equipment is a battery-operated dog that 
walks and says 'bow-wow'. The children 
indicate to me by the signs for "walk"' or 
"talk"' whattheywantthe dog to do. In this 
way we elicit spontaneous signs and/or 
words. Most of the children respond 
appropriately (i.e., in sign language) when 
asked their name. It is very important to 
use their names in a pleasant manner, for 
example in songs. Those who are unable 
to do so, will imitate their own name signs 
after being shown. 
At "'sit and talk" time the children are 
asked what they would like to talk about. 
They choose by sign or sound from a box 
that contains pictures, puppets, etc. One 
day there was no response from anyone, 
not even Jamie the most responsive, 
dependable child "leader."' 
This is what happened: 
Instructor: "'Shall we talk about a bus?" 
Jamie: folds his hands and shakes his 
Instructor: "Shall we talk about a bird?" 
Jamie: negative again. 
I was shocked! Jamie did not want to 
do anything. I looked at Helen - she 
shook her head. I looked at Rick - he 
shook his head. It took me a few seconds 
to grasp the significance of their reaction 
Jamie was thinking! He was making a 
decision and standing by it! 
On another occasion, I was busy with 
Nancy, who was beginning to sign and, 
therefore required a considerable amount 
of my time. Jamie tapped me on the 
shoulder. All Jamie s communication is by 
I gesture. He can only make a "ba"' or an 
"'aa" sound. He signed butterfly on the 
flower. The message was very clear: he 
was not getting enough attention and, 
feeling that he should be included, he 
decided to make me aware of his 
presence. This was evidence that Jamie 
was thinking, communicating, and 
managing his environment. It is important 
to recognize that these were not reflexive, 
impulsive acts on his part, but were the 
result of logical thought processes. Of 
Course the reward for this conversation 
and all that it implied, were hugs and 
laughter from us. and butterfly on the 
flower for Jamie. 
Group dancing and partner dancing 
give the children occasion to socialize and 
cooperate as well as move around during 

the session. Dancing also aids in the 
development of coordination and body 
awareness and is a good way to teach 
such things as boy, girl, and other signs 
A child may request by signing that we 
dance or playa record - an excellent 
way to socialize and get approval from the 
rest of the group. 
Language acquisition and speech 
development (where possible) are 



long-range goals. We do not offer the 
children any material reinforcements. 
Certainly, if we did provide 
reinforcements, we could elicit 
predictable responses at scheduled times 
but the children would still only produce 
isolated sounds and gestures. It would 
take years of training and bushels of 
Smarties to produce enough words or 
signs to communicate effectively. The 
rewards these children receive are the 
feelings of confidence and self-esteem 
they earn through their accomplishments. 
The social approval of the volunteers, 
staff and other children is reward enough 
All the eleven children of one group 
and seven of another have shown 
progress. They have advanced from one 
to two orthree simultaneous signs and/or 
words. Some are speaking or gesturing 
spontaneously to communicate; others 
have remained at the level of imitation. It 
is important to keep trying with all the 
children - we do not know for sure why 
signing works or when it will work. My 
contention is that the accepting, happy 
atmosphere and the ability of music to 
stimulate emotional response in these 
children, in conjuction with an eclectic 
approach that encourages input from 
many sources, are responsible for the 
success of music-signing. 
One of my little friends is a boy who 
was non-verbal and was only able to 
make incoherent sounds a year ago. One 
day he was listening to "Look."' a song 
from a Sesame Street record that we had 
played a few times. He jumped from his 
chair, ran to the window, opened the 
curtain and said clearly and distinctly, 


. . ... 
..,....... , 
. . . . . ......... 
"" A... 

'S .... 
. \

.11 .iIfI" 
.. ... . 
It.. .... 
'. ..-. . 
4 -.. 
, . .. 
. . . 

"look car."' At the same time he made the 
sign for "look" and went around to each 
child in the circle saying,"'ook car, look 
me, look tree," etc. An "I" is a difficult 
consonant to pronounce and his 
articulation waS perfect! 
No diagnostic labelling, no 
assessments or tests, and no data to 
analyze. All these have been intentionally 
avoided in our program. Instead, we 
concentrate on the children and their 
individuality. The success of the 
music-signing program is in the happy 
face of the child who is understood, who 
knows that he can understand, and in the 
enthusiasm of the little fellow who 
combines signs, song and speech to say, 
"Look car, look tree, look me."... 

MaryDean Samanski (above) who wrote 
"Singing, Signing, Smiling," is a Registered 
Nurse with extensive experience in the field of 
psychiatry and mental retardation. For the 
past six years. she has worked as a 
Recreation and Crafts Counsellor, employed 
exclusively in music programming. Since 
September 1 976, she has been On leave of 
absence from Durham Centre for the 
Developmentally Handicapped at Whitby. 
Ontario. She describes her studies In "Early 
Childhood Education" as "an attempt to 
supplement my years of pracDcal experience 
with theory" and says that she is finding her 
sabbatIcal "very enlightening. " 
She is a member of the Canadian 
Association for Music Therapy, Ontario Music 
Therapy Association, Or" Society of Canada, 
College of Nurses of Ontario and Canadian 
Society for the Prevention of Cruelty to 

The Cønødlen N ursa Februøry 1977 

fI[J[JIJlJrli[ìrliliilJ: a professioné: 

Muriel A. Poulin Public confidence in the health care system 
particularly in the medical services - and in 
the mind of the publi c the two are synon ymous 
- is at a low ebb. News media reports of 
spiralling costs and consumer demands attest 
to obvious consumer disenchantment. For 
years we have believed the propaganda that 
Western, and particularly North American, 
health care is the world's best. There is 
evidence, however, that for the human and 
financial resources we expend, and 
considering the fact that we represent some of 
the most technically advanced countries in the 
world, the system is ailing. 1 

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Nursing as a Primary 
Health Profession 
As part of that system, what is nursing's 
state of health? What is nursing's role and its 
responsibility in assuring that the health care 
delivery system is revitalized and made 
whole? If we are to be accountable as 
professionals we must give some thought to 
what it is that makes nursing unique among the 
health professions and to what it has to offer 
the consumer. Three key elements of nursing 
require clarification and reassessment: 

1. The Nurse as the Client's Alter Ego 
The various criteria or characteristics of a 
profession are familiar to all of us. There is 
some agreement that these include a body of 
knowledge, a code of practice, professional 
organization, and client service. In my opinion, 
the critical element is the service focus. It is 
within this frame of reference, a client 
orientation, that we must clarify our role in the 
system. Our first responsibility is to the client 
- the patient - or to an aggregate of clients or 
patients that is, the society in which we find 
In the typical bureaucratic organizations 
in which we function, we have all too often 
allowed policies, routines and regulations to 
dominate and determine the role of patients. 
We have ignored individual needs and their 
implications for organizational change and 
have worked to maintain the organizational 
status quo rather than to meet needs of 
patients. It is time that each of uS recognized 
that as a primary health -::are profession we are 
accountable - not to the organization, not to 
the medical staff, not to the system - but to 
the clients we serve. This is our first 


2. Code of Ethics 
Nursing has persuaded society that it should 
have certain powers and privileges, among 
them, control over nursing education, 
admission into the profession, and licensure. 
As evidence of its ethical posture, the 
profession has a code of ethics which is a 
commitment to its clients. The International 
Council of Nurses has a code that has been 
approved by member organizations of the ICN 
including Canada. In the United States, the 
American Nurses Association has developed 
a code specific to the American scene. These 
are all forms of contracts with the patient and 
with society and I suggest it is high time for us 
to reassess our responsibilities within the 
context of these stated beliefs and to 
determine clearly our accountability. 

3. Standards of Practice 
The standards of practice enunciated by a 
profession are another form of "contract" with 
clients. As they stand now, the Standards of 
Nursing Care enunciated by the Canadian 
Nurses Association imply competencies 
representative of primary care professionals. 2 
The question facing us is whether we will 
indeed function according to the standards 
and hence as primary care providers; whether 
we will indeed function to the extent of the 
potential inherent in the nursing profession. If 
we are going to try to alter the system, we must 
first answer this crucial question concerning 
our role in it. 
There is no doubt that the system will be 
altered and that the change will involve a 
power struggle of many groups and elements. 
Whether or not nursing will have significant 
input into that change will depend on its 
competence and confidence as primary care 
Throughout its history, nursing has 
maintained altruistic goals but altruism withcut 
authority is seldom influential. All too often our 
aims have been mighty but Our "might" has 
been aimless. If we believe in our professional 
goals, it follows that we support the position of 
our professional organization. We accept its 
code of practice and we identify with the 
profession. Professional associations of 
nurses, cutting across the many spheres of the 
occupation, at the local as well as national and 
international levels, offer one of the most 
promising means of achieving nursing's aims. 
It is only through collective action that the 
authority of the profession will be exercised. 
The role of professionals and their 
professional organization in determining 
standards and controlling practice is 
something we need to look at. We are living in 
a period in which the quality of the health care 
system is being questioned and at the same 

time better qualified practitioners are being 
introduced into the system. Graduates of 
baccalaureate programs can be expected to 
exert mOre and more influence as they 
demand a greater voice in determining 
practice. Those of uS who are already in the 
system will be forced to decide whether we 
identify with nursing as part of the system or 
with particular institutions. One need not 
negate the other but priorities must be 
decided. Values must be weighed and a 
balance established between client needs and 
organizational responses to these needs. 

Barriers to Professional Development 
Today, the quality of care in many 
countries is not equal to the human and 
technical potential that exists in these 
countries, including, probably, Canada. 
Organizational, political and legal constraints 
have functioned to limit roles and to restrain 
group and individual development. If you think 
this is too broad a statement, consider: 
. the failure of nurse-midwives to gain 
. the role of the nurse today compared to 25 
or 30 years ago. Formerly the nurse provided 
most of the care except for the physician's 
diagnosis and medical orders. In terms of the 
knowledge of that day, both roles were 
"extended'" There was a complementary lack 
of knowledge, whereas today both have a 
firmer knowledge base. Why did the 
knowledge: practice ratio in nursing fail to ke
pace? We are not, on the whole, providing the 
quality and type of care possible in relation to 
the knowledge base available to us. 
. the specialist role today compared to the 
head nurse role two or three decades ago. The 
head nurse was truly a primary care worker 
and clinician - in the real sense of the word- 
again in relation to the day's knowledge. Why 
was the role not maintained through the 
. failure to include third-party payments to 
nurses as national health insurance plans 
developed. Did this contribute to full utilization 
of nurse potential? 
Obviously, nursing has not yet found its 
appropriate role in the structure of tOday's 
health care system. I believe that there are four 
major forces in society that have conspired to 
prevent our role enactment as professionals: 
medical dominance, female subservience, 
political naiveté, and low visibility. These 
constraints know no barriers and influence all 
of us, regardless of position. 

Medical Dominance 
There is no doubt that the dominance of 
the medical profession in the health care 
system has seriously limited the axercise of 

nursing's potential and thus the quality of 
health care in general. The tendency of 
medicine, particularly organized medicine, to 
concentrate on the interest of its own 
professIon has not always been in the best 
interest of the larger society. Its efforts to 
maintain the status quo rather than encourage 
social developments are well documented. 3 
Much closer to our own professional 
practice is medicine's newly awakened 
interest in the broad health picture. With the 
development of family nurse practitioners who 
can deal with the broad spectrum of family 
health needs, we must expect more 
involvement from medicine in health - as 
opposed to illness - care. 
In my opinion, control has evolved largely 
as a result of medical chauvinism. However, I 
believe that the practice of increasingly 
competent nurses will result in lessening of the 
medical mystique and greater awareness on 
the part of everyone that M.D.'s are not gods, 
but people of a scientific endeavor, with all the 
limitations, as well as skills, of mortal beings. I 
also believe that medical dominance cannot 
be considered outside of the male-female role 

Women's Role 
I agree wholeheartedly with Rothberg, 
who states that "our oppression as women 
health workers today is inextricably linked to 
our oppression as women..."4 We have 
traditionally faced overwhelming conditioning 
and indescribable brainwashing in learning 
women's "proper" role. As we all know, 
women's role is not intellectual. It is emotional 
and it is family-centered. It is dependent and 
non aggressive. It is not, of course, a 
leadership role! 
However, things are changing and there 
is an opportunity in today's society, particularly 
with the women's movement, to assert 
ourselves. It is now more acceptable for 
women to take definitive, initiating roles. 
Women are increasingly career oriented, 
regardless of their level of education, and 
more and more of them are working outside 
the home. It is obvious that the focus of activity 
for many of us is not in the home. Our lifestyles 
require satisfaction in contributing to and being 
"part of the action." In view of the state of the 
world, which is an outcome of long male 
dominance, I suggest it is long past time for 
women to playa greater leadership role in all 
aspects of our society. 
Certainly, as health care providers, we 
must become more assertive. Failure to 
question what we consider shortcomings in 
care is a disservice to our patients. If the 
quality of care is to be improved, nurses must 
function to their full potential. This means 


ne anaLlan ,urse etruøry 


throwing off the subservient role of women and 
maintaining active involvement in 
decision-making as health care providers. 

Political Naivete 
We live in the midst of political structure 
and yet we are politically naive. In the health 
care system and In the individual health care 
agencies, there are definite power bases, 
power centers and power structures. There is 
continual competition for control and obvious 
shifting distributions of power Relationship 
patterns display a variety of combinations of 
coalitions and alliances and a wide range of 
negotiation styles are evident in the many 
Unfortunately, nurses have usually been 
on the fringe. We've avoided confrontations 
rather than acquiring skills in negotiations. 
We've developed patterns of avoidance rather 
than confidence in risk-taking. We've avoided 
true leadership roles rather than face conflict 
In the arena of power and authority, 
nurses - women, mostly - have been 
"programmed for failure." Authority to make 
decisions may be frightening, or at least 
anxiety-provoking, for it means breaking out of 
the security of dependency roles and being 
held accountable for the results of our 
It also means the need for discriminatory 
judgment in understanding the nature of power 
and the values of shared power. We are living 
in a time when the dominance of anyone 
group is to be deplored. Effective use of control 
will focus on public rather than on private 
interests and, for us, it will focus on providing 
nursing care services for all. If we are truly 
serious about our goals of meeting nursing 
needs of patients, we must be responsive to 
the pOlitical struggles going on in many of our 
agencies, and we must be equally serious 
about our involvement in policy 
Such involvement will depena on me 
power and prestige afforded us in these 
agencies but we must avoid the trap of 
acquisition of power solely as a struggle for 
prestige and control. We must be cautious that 
use of power is for positive purposes. We must 
maintain our goals and focus the power we 
acquire on goal achievement: i.e. health needs 
of the people. 
My concern is with the existing imbalance 
in the power structure of the health care 
system to the patient's disadvantage. And it is 
with nursing and its appropriate role in that 
structure and system. 




Low Visibility 
In order to attain power in any system, a 
group must have recognized status and 
prestige based on a variety of factors such as 
wealth, expertise, political popularity, position 
in formal organizations and numbers. Nursing 
is not likely to achieve its strength from an 
economic base in the near future. It has the 
potential, however, of achieving strength 
based on expertise in a critically-needed social 
service, and certainly it has the potential for 
power based on numbers. 
It is time for us in nursing to change our 
public image, to improve Our visibility, to inform 
the public of the extremely essential and 
positive contribution made by nurses and the 
nursing profession. 
For too long we have shied away from 
self-aggrandizement as a profession. I 
suggest that we, as individuals, must inform 
the public of nursing's contributions; but I also 
suggest that it is time that our collective efforts 
be directed toward a massive public relations 
campaign, one that will inform the citizens of 
our society of the primary and prominent role 
played by nursing in the total health care 
scheme. The public must be told how nursing 
is, and could be, contributing to its health 

Recognizing our accountability 
Paraphrasing Freud's question: "What 
do nurses want, my God, what do they 
want?" Essentially, I believe, we want greater 
freedom; freedom to function to Our fullest 
potential, to contribute as primary health care 
professionals and to determine our own 
destinies as essential health practitioners. We , 
want equity in our focial and economic status. 
We want an end to the medical dominance of 
the health care system with its major thrust of 
medical care rather than consideration of total 
health needs of our society. 
The next five to ten years will be critical 
ones for the nursing profession and for the 
health care system. The effects of economic 
problems and cutbacks in health expenditures 
are already being felt. As nurses who accept 
our professional accountability, what can we 
do? The first step, it seems to me, is to get 
involved, both individually and collectively, in 
all aspects of change. I would recommend 

. Initially, we must commit ourselves to 
:>assessing our beliefs relative to nursing 
ractice. Regardless of the setting or the 
osition in which we function, basic beliefs 
lust be clarified. 
. We must reaffirm the primary role of nursing 
.nd the inherent authority residing in that role 
Ve must speak up as knowledgeable 
ractitioners in our daily practice, whether as 
taff nurses, administrators or educators. 
. We must assume individual as well as 
ollective responsibility to interpret nursing's 
,oie to members of the public as well as to 
,ther health professionals. 
. We must be confident in our roles as 
!rofessional practitioners. We must all throw 
)ff the shackles of the traditional, subservient 
1I0men's role and function as full human 
Jeings. Whether male or female, recognize 
(our worth as professional nurses. 
-. We must inform ourselves of the power 
Fenters in our agencies. We must all "tune in" 
tnd utilize the political structure in achieving 
.1Ursing care goals. We must choose leaders 
:vho are educated, intelligent, articulate, and 
vho have the inner fortitude to stand up for 
I rVha
 they know is right for the patient and for 
). We must overcome the anti-intellectualism 
;0 pervasive in our ranks and recognize that 
mly in functioning on a par with highly 

ducated, well prepared, scientifically oriented 
',ealth professionals will we influence 
jevelopments In the health care system. 
7. Finally, we must strengthen our professional 
Jrganizations, local, national and 
nternational. Collective action can accomplish 
Nhat individual effort cannot 
I believe we must define our beliefs and 
jevelop the inner fortitude and commitment 
jleCessary to take an aggressive and initiating 
I ole in promoting change in the health care 
:;ystem. We must become increasingly 
:;elf-conscious about our practice, our 
'3ducational preparation and our research. We 
:"ust recognize our accountability and function 
'as the patient's advocate. 
We have a vital stake in the health care 
system, not only as providers but as 
Iconsumers as well. The system of the future 
:lIIIill depend in large measure on our ability to 
clarify our roles. It will depend on our 
.astuteness in planning strategies for 
l.Jvercoming barriers to our role enactment as 
iprimary health care professionals. In short, it 
Iwill depend on our ability to demonstrate our 
,accountability as professionals and as a 
'profession. In the days ahead, this is the 
limperative that nursing will have to face.... 

Muriel A. Poulin, R.N. Ed. D., FANN, author of 
"Accountability: a profesSional imperative," is 
professor and coordinator of the Graduate 
Program in Nursing Administration, Boston 
University School of Nursing, Boston, Mass. 
She received her doctorate from Columbia 
University in New York. Dr. Poulin believes that 
"we have traditionally faced CNerwhe/ming 
conditioning and almost indescribable 
brainwashing in leaming women's 'proper' role" 
and points out that women have only recently 
begun to CNercome some of their inhibitions. "In 
view of the state of our health care system," 
according to Dr. Poulin, ''it is time for nursing to 
exert sound and definite leadership." 
This article is based on an address she 
gave to mark the opening ceremonies of 
Memorial UniversIty School of Nursing's 10th 
anniversary celebrations in St John's, 
Newfoundland, last Fall. 

1 Example: Lalonde, Marc. A new perspectjv
on the health of Canadians; a working document, . 
by... Minister of National Health and Welfare. 
Ottawa. Information Canada, 1974. 
2 Canadian Nurses Association Guidelines for 
developing standards for nursing care. Ottawa, 
3 Harris, Richard. The sacred trust. New YorK, 
New Amencan Library. 1966. 
4 Rothberg, June S. Nurse and physician's 
assistant; issues and relationships. Nurs. Outlook 
21:3:154-158. Mar. 1973. 



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"The popular press and lay science writers exhibit an 
understandable fascination with the more exotic possibilities of 
genetic engineering: test tube babies, chimeras, and clones. But 
while they write and societies fantasize about spectacular events 
which may take place in upcoming decades, they often ignore the 
qUiet and more muted revolution in human genetics which is 
occurring right now - a muted explosion ... of knowledge and 
techniques which may be having more impact on parenthood, on 
the family, and on the rearing of life itself than cloning ever will... ", 


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Lucille Pakalnis, Josie Makoroto 
Any discussion of man's investigation into the 
reproductive process is guaranteed to evoke 
strong reactions, ranging from praise and 
enthusiasm to condemnation. There is 
scarcely an area of human endeavor mOre 
heavily shrouded in myth than that of 
reproduction. But right now, investigation into 
reproductive technologies is going on; 
knowledge in this area of the medical sciences 
is proliferating rapidly. The development of 
technologies attending such knowledge 
ensures that its influence is being felt more and 
As nurses, we are closely involved in the 
technologies; first as professionals in the 
health field, especially in the care of patients in 
research units; secondly, as members of a 
society whose fabric and structure may be 
affected by their use. 
The work going on in the reproductive 
technologies carries with it a range of 
questions, a number of serious ethical and 
moral Implications. But for the present, let us 
look at where the reproductive technologies 
are now, and at where they may be going. Our 
bibliography suggests a fraction of the works 
available on the implications and possibilities 
inherent in the development of such 
technologies, but we will look at the 
technologies themselves. 

Hands Off...? 
Public response to what is happening in 
the area of reproductive technologies seems 
to be related to the perceived motivation for 
research. Acceptance is greater when the 
result of research is more than merely 
informative. when it is perceived as being 
helpful to people. For this reason, Edwards 
and Steptoe in England have had little difficulty 
in finding volunteers for their research, (which 
includes in vitro fertilization) because their 
motives are seen as humanitarian; they wish 
to offer help to childless couples through their 
studies. 2 
But an uninformed public cannot make a 
sound judgment; the 'unknown' threatens. And 
in the area of human reproduction, there are so 
many unknowns involved. FOr example. we 
are just beginning to be aware of the 
tremendous effect the prenatal environment 
- the same environment such research 
attempts to recreate and work within - has on 

Fig. 1 Reproductive Technologies: 
Goals, Problems and Questions 

1) to understand the actual process that occurs during fertilization. 
2) to assist fertilization in childless couples. 
3) to enable- monitoring of pregnancies, in order to detect genetIC 
defects, (e.g. Tay Sachs disease and Mongolism) and 
cure/eliminate/abort these. 
4) to supplement/replace natural reproduction with lab methods 
(IVF-IVC) to allow greater control over the number and quality of 
5) to alter the genetic pattern ofthe fetus, either to correct an existing 
error or to enhance a particular "favorable" trait. 

Problems and Questions 
1) currently, artificially produced embryos cannot be maintained to 
viability, and must be sacrificed. 
2) "About 10% of couples are infertile due to genetic defect" 5 This 
defect could thus be perpetuated through genetic assistance 
3) some will escape detection due to lab error or sheer number of 
pregnancies to be screened. How wIll society treat these 
4) would remove reproduction from being a family event; 
depersonalizing; could normal psychic development of the fetus 
5) DNA structure is extremely complex - there is danger of 
accidentally inducing further damage with repair attempts; could 
interfere with natural mutations allowing adaptation to our 
evolving environment, and jeopardize our race's surviv 

the ultimate outcome of the fetus. 3 ,4 
Another area of concern hinges on the 
status of the fetus in the eyes of the 
researcher.lsthe fetus in fact, ahuman being, 
with the rights of a human being? Is it on a par 
with lab animals, such as rats and mice? Is it a 
discrete tissue, useful for organ function 
studies? The question needs an answer, as 
such an answer will form the basis for the 
course of the research itself. 
Public reactions to investigation into the 
reproductive technologies tend to be strong, 
whether in favor or in opposition. This can be 
expected because such investigation goes to 
the heart of what man is, or seems to be, and 
presumes to alter that somehow. But valid 
opinions must be based on fact and not on 

At the heart of the research, is a sincere 
appeal to go beyond myth. beyond the 
sacrosanct "hands-off' approach to 
examining such a fundamental aspect of 
humanity; to attempt to discern what is 
essence and what is explanation; to be able to 
act out of choice rather than because of 
limitation; and thus to arrive at a clearer, more 
accurate understanding of man's place in the 

The goals of research into human 
reproduction are attended by problems and 
very fundamental questions. Some of these 
are outlined in Figure 1. 

What is going on... 
The various techniques described seek to 


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understand and enhance the processes 
involved in the fertilization of a human ovum. 
They are depicted in Fig. 2 

Artificial Insemination 
Artificial insemination has long been used as a 
practicai, efficient means of breeding animals. 
This procedure is now popular in assisting 
fertilization in childless couples. An estimated 
10,000 children are born annually in the U.S. 
through the use of this method. 6 
Sperm from the husband or a suitably 
matched donor are injected by syringe into the 
woman's cervix at the time of ovulation. The 
sperm may be fresh, or have been previously 
collected and frozen for storage. Impregnation 
frequently occurs after two or three such 
treatments. Several problems are created by 
the possibility of artificial insemination: 

. donors must be found with similar 
physical and intellectual characteristics to the 
. donors must be found who have families 
free of known genetic defect 
. religious, psychological and legal 
complications must be dealt with; they tend to 
cause further distress if marital discord 
. feelings of inadequacy in the husband 
must be dealt with; the common 
misconception confusing sterility and 
impotence must be cleared up 
Controlled Ovulation and Harvesting of Ova 
Under controlled hormonal stimulation, a 
woman's ovaries can be induced to mature 
one or more ova on a schedule known to the 
researcher. These ova are then removed by 
laparoscopy and aspiration. From the 



woman's point of view this procedure entails 
little risk; but the chance of damaging the ova 
removed by a method relatively violent to them 
is great. 

In Vitro Fertilization 
The harvested ova may then be fertilized in 
vitro (i.e. in glass, a test tube) with the addition 
of human sperm. Visualization of this process 
by means of a microscope has revealed what a 
complex procedure fertilization actually is. 
Rather than occurring at a given moment, it 
spans a time period of up to 12 hours, with 
several discrete steps between contact of the 
sperm and ovum, penetration, and fusion of 
the nuclei. Any disrupting influence (i.e. 
bacterial/viral contamination, altered 
chemical environment, etc.) could lead to 
failure or to defective development of the 
resulting embryo. 





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In Vitro Culture 
In order to determIne that IVF has in fact, 
occurred, and that cell division is progressing 
normally, the embryo is maintained in a 
chemical bath and observed closely. As yet, 
this may only be continued up to the blastocyst 
stage, or 64 cell divisions, the stage at which 
the fertilized ovum is normally travelling down 
the fallopian tube to the uterus. Beyond this 
stage cellular specialization and organ growth 
begin, producing the as-yet-unsolved 
problems of oxygenation, nutrition, and waste 
disposal, normally provided for by the now 
implanted embryo.s placenta. Once the IVF 
embryo has reached this stage of 
development, the researcher is faced with 
three options: to attempt reimplantation of the 
embryo into the uterus for intrauterine 
gestation, to attempt to continue IVC with an 
artificial uterus, or to discard the embryo. 











A major difficulty lies in the fact that the 
only apparent way to discover a supportive 
artificial environment is to expose the embryo 
to a series of hostile ones, a process of 
elimination. An entirely new living organism is 
created by IVF, and then because of our 
limited knowledge. exposed to what must be 
considered to be lethal conditions. 

Embryo Re-implantation 
It is at this stage that such scientists as 
Edwards and Steptoe. are trying to devise 
methods for transferring the embryo back into 
the uterus for lUG (intrauterine gestation). 
One method involves an abdominal 
incision into the uterus. but this has its 
drawbacks. It requires major surgery and 
traumatizes the uterus, which may lead to 
spontaneous abortion. 
A more promising method lies in the 






insertion of a fine tube through the cervix and 
injection ofthe embryo into the uterus. To date, 
most sources state that this has not yet been 
accomplished (most embryos fail to implant. 
and one implanted in the fallopian tube). One 
researcher, Dr. Shettles of Columbia 
University, claims to have succeeded using 
the syringe procedure on a woman scheduled 
to have a hysterectomy. At operation, two days 
after the reimplantation examination 
showed that it had implanted properly.....] 
For the sake of completeness, cloning should 
be mentioned, but the technical problems 
involved with such a delicate maneuver are 
such that it seems a much more remote 
In cloning. the haploid nucleus I 
(containing half the normal complement of 


human chromosomes, or 23) is removed from 
an ovum and replaced with a diploid nucleus 
(containing all 46 chromosomes), perhaps 
from an intestinal cell. The now "fertilized" 
ovum begins to divide and ultimately produces 
an individual identical to the donor of the 
diploid nucleus, To date, this has only been 
done with reptiles such as frogs and 
salamanders, although work is progressing on 
perfecting the technique in mammals, 

Scientific investigation into the 
reproductive technologies is going on, and its 
going on now. The 'muted explosion' of 
knowledge and techniques is already making 
itself felt in the areas of artificial insemination 
and prenatal genetic testing and counselling. 
Man as we know him, and all that we call life, is 
under close scrutiny. 
Microscopic exploration is giving rise to as 
many questions as the answers it uncovers. 
With advances in this area, new dilemmas and 
responsibilities are created, The 
establishment of centers for bioethics is an 
expression of the need for answers to the 
puzzles created by scientific investigation and 
proliferating knowledge. 
Perhaps our first responsibility is to be 
aware as much as possible of what is going on 
in the sphere of reproductive technology. From 
here, we can begin to deal more knowledgably 
with the questions that will confront us. ... 

About the Authors 
This article evolved from a course in 
bio-medical ethics attended by the authors at 
the University of Sudbury. Lucille pakalnis 
(R.N., Montreal General Hospital School of 
Nursing, Montreal, Quebec) and Josie 
Makotoko (R.N., South Africa: P.H. 
Aberdeen) both ha ve extensive obstetrical 
experience, having worked in England, the 
West Indies, Africa and Canada. Currently, 
both are living in Sudbury, Ontario. They feel 
that the subject of reproductive technology is 
one "of tremendous importance to all nurses, 
both personally and professionally. At present 
Canada has no formal policy governing such 
research, and the public at large is similarly 
unaware and uninvolved in the matter. This is 
a very unfortunate state of affairs, as 
ignorance of any aspect of nursing having so 
potentially profound an effect on our lives is a 
serious handicap." 

1 Twiss, Sumner B. Genetic responsibility. In 
Great West Life Assurance Co Dilemmas of 
modem man. Winnipeg, 1975. p. 65. 
2 George, G. Life in the lab. Natl. Observer 
12:27:1, Jul. 7, 1973. 
3 Leboyer, Frederick. Birth without violence. 
New York, Knopf. 1975. 
4 Lake, A. New babies are smarter than you 
think. Woman's Day Jun. 1976. p. 22. 
5 Gorney, Roderic. The human agenda New 
York, Simon & Schuster, 1972. p. 232. 

11IIõI'' I . 



6 Leach, Gerald The biocrats. Baltimore, 
Penguin, 1972. p. 86. 
7 Rorvik. David M. Taking life in our own hands: 
the test tube baby is coming. Look 35:921 :86, May 
18, 1971. 

Suggested Reading 
1 Augenstein, Leroy G. Come, let us play God. 
New York, Har-Row, 1969. 
2 Berthold, Jeanne Saylor. Advancement of 
science and technology while maintaining human 
rights and values. Nurs. Res. 18:6:514-522, 
Nov.lDec. 1969. 
3 Callahan, Daniel. Human rights: biogenetic 
frontier and beyond. Hosp. Prog. 54:9:80-84, Sep. 
4 Commoner, Barry. The closing circle. New 
York, Bantam, 1972. 
5 Fletcher, Joseph. The ethics of genetic 
control: ending reproductive roulette. New York. 
Doubleday, 1974. 
6 Fuller, Watson ed. The biological revolution: 
social good or social evil. New York, Doubleday, 
1972. - 
7 Hubbard, William N. Human biology medical 
ethics. Univers. Mich. Med. Centre 33:49:53, 
Mar.lApr. 1967. 
8 Hyde, Margaret O. The new genetics: 
promises and perils. New York, Watts, 1974. 
9 Ramsey, Paul. The ethics of fetal research. 
New Haven, Yale Univers. Pr., 1975. 
10 -. Fabricated man: the ethics of genetic 
control New Haven, Yale Univers. Pr., 1970. 

Statistics show that a large percentage of 
patients discharged from conventional 
psychiatric facilities are readmitted, not 
because of recurrence of pathology, but 
because of their inability to cope with what 
to them is an alien and hostile world. As 
one alternative to traditional psychiatric 
care, nurses working at the Lakeshore 
Psychiatric Hospital established a 
self-care unit on an experimental basis. Its 

staff members were confident that the 
supportive environment they were able to 
provide and its emphasis on greater 
patient responsibility could ease the 
transition for patients from hospital to 
community and result in fewer 

The self.. care Dnit
a bridge 
to the community 

Patricia Bamngton 

Patient Study No. 1 
Twenty-four-year old John Gordon" was 
admitted to Lakeshore Psychiatric Hospital for 
the second time in March, 1975, One of five 
children of divorced parents, he had a long 
history of mental retardation even though he 
had completed Grade 8. Psychological testing 
done at the hospital showed a dull normal 1.0. 
with social and emotional immaturity. 
Following the previous admission, John had 
spent a year and a half in a sheltered home 
before being removed by his father, and sent 
back to his mother in March 1975. John's 
mother resented this, and the resultant 
problems precipitated his current readmission. 
When John was first transferred to the 
Self-Care Unit in July, he annoyed fellow 
patients and staff with his chIldish tricks and 
immature remarks. When he did not receive 
the attention he wanted. he would go off by 
himself and sulk. In contrast to this behavior, 
however, he took responsibility for the tasks 
assigned to him on the unit and obtained a job 
with Hospital Services. He surprised the staff 
there with his efficiency. reliability and 
intelligence. With frequent reassurances from 
staff and co-patients, John became better able 
to interact on an adult level and was soon 
talking about discharge plans. His medication 
was gradually reduced and then discontinued 
With help from staff he found a basement 
apartment in the community and upon 
discharge, moved in with a fellow ex-patient 
from the Self-Care Unit. Both young men 
managed very well cooking their meals, and 
working regularty. Also, John's relationship 
with his mother improved dramatically and she 
asked him to accompany her on a vacation. 
John has remained stable and self-sufficient in 
the community and continues to perform at a 
high level at his job in Hospital Services. 

. Names have been changed and derails altered 10 prevent 
Identoficatlon 01 IndivIduals bullhe essentoal facts are ta
órectly from lhe hlslones of three of lhe pallents wt10 took pari 
In the program. 


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In July, 1975, we established a Self-Care Unit 
on an experimental basis at Lakeshore 
Psychiatric Hospital in Toronto. It was 
designed to provide a commune-type 
atmosphere for ten to twelve chronic male 
patients between the ages of eighteen and 
forty-five. Operated by one R.N. and one 
R.N.A., 24 patients have stayed on the unit 
over a 7-month period. Four of these patients 
were transferred back to their original units 
because they refused to accept the 
responsibility which went with the additional 
freedom offered in the Self-Care Unit. Twenty 
patients, John Gordon among them, have 
been discharged to the community and have 
not required readmission. 

A self-care unit setting provides a 
psychiatric patient with a transitional 
experience to bridge the gap between hospital 
and community living. In this warm, caring and 
supportive environment, our goal is to help the 
patient to relearn and practice living skills and 
to develop a feeling of responsibility towards 
himself and his fellow patients, thereby 
increasing the probability of his successful 
return to the community. By nature of its 
minimal equipment and staffing, its reduced 
number of readmissions and its subsequent 
reduction of hospital bed occupancy, it also 
offers a maximum of economy in a time of 
financial constraints. 
A typical program which initiates and 

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promotes a sense of responsibility in the 
patient towards himself and others may 
. a written committment or contract by thl 
patient regarding his goals, objectives and ! 
probable length of stay in the Self-Care Uni1' 
. responsibility for household chores on ' 
commune basis 
. responsibility for personal medication I 
. preparation and serving of breakfast art 
lunch in the Unit I 
. participation in group discussion to 
encourage communication and the 
development of insight I 
. assistance in voluntary work in various 
hospital departments for specific periods I 
every day 
. discussion of job possibilities and 
opportunities or various upgrading program 
available in the community I 
. participation in the investigation of 
suitable accommodation and social 
recreational facilities in the community. 
Mature and experienced staff are 
necessary to provide the consistent suppor I 
and guidance that each patient in the self-car 
unit needs. As the noted psychiatrist, Dr. I 
William Glasser states, the staff must achiev' 
"the proper involvement, a completely hones 
human relationship in which the patient, fOI 
perhaps the first time in his life, realizes th'i 
someone cares enough about him, not only 'I 
accept him, but to help him fulfill his needs i 
the real world." The staff of a self-care unit 
must have the personality and maturity to I 
direct such a program. 
To maintain the continuity of personal' 
contact that is the very heart of the program 
staff members should be on fixed hours rath 
than rotating shifts, so that patients know Wh( 1 1 
and where they can find the particular 
individual they wish to consult. 
Prior to their transfer to the Self -Care Un 
many of these patients had poor prognose: 
but the changes that have occurred are I 
considered remarkable by the staff of the 
hospital. The studies that follow serve as 
examples of the progress psychiatric patien 
can make in a self-care unit environment. 

Patient Study No.2 
Larry Black was 24 years of age with a Grade 
XIII education. His mother and father were both 



Jrofesslonal people and he had two younger 
,isters. His first admission was as an 
nvoluntary patient after being transferred from 
J general hospital with a diagnosis of 
3Chizophrenia. In November 1974, Lalry had 
:Jeen difficult to handle and had left hospital 
5everal times. 
During his first admission to Lakeshore he 
Has withdrawn, Isolated and seclusive. He was 
treated with Chlorpromazine until his discharge 
to a private sanatorium. One week after his 
discharge from the sanatorium, he was 
readmitted to a general hospital. When the staff 
Ifound him difficult to manage. he was again 
readmitted as an involuntary patient to our 
I hospital. 
Upon admission, Larry showed thought- 
olocking, delusions and experienced auditory 
hallucinations. He also had a history of 
self-destructive acts, and, one hour after 
admission made an attempt to jump out of a 
third-floor window, but was restrained by staff. 
With the administration of electro-convulsive 
therapy and phenothiazines, the psychosis 
i subsided quickly but he still remained 
I In early April, plans were made to place 

 Larry on day care. However the weekend 
I before his discharge, he slashed both his wrists 
, at home. In May, he began working in Industrial 
! Therapy, but again, slashed his wrists after an 
, upset caused by a fellow patient. 
Over the summel months, Larry showed 
some improvement. His general affect was 
good and he was verbalizing more. In 
September, he started a general preparatory 
, course at a Community College but he seemed 
I anxious about it. His medication at the time 
I Included Chlorpromazine, Moditen, Stelazine 
and Kemadrin. 
When Larry arnved in the Self-Care Unit, 
I he was very shy and withdrawn. At first, he was 
! reluctant to speak out at the morning group 
, sessions, but as he got to know his fellow 
patients and staff he was able to express his 
opinions quite well. Larry took responsibility for 
the duties assigned to him. He attended his 
, Community College course daily and spent 
I weekends with his parents. After awhile. he 
told us of his real fears about pursuing higher 
I education. He felt that his family expected this 
of him but he preferred to work at something 
less intellectually demanding. In solving this 
conflict, Larry made plans to get a job and 
completed all the necessary arrangements 
himself. At the end of December, he was 
discharged to a halfway house, suggested to 
him by the staff, and there, experienced greater 
independence and became popular with the 
other men in the house. 
Although he had needed a great deal of 
positive reinforcement and support to make 
these moves, he made them. and has not been 
readmitted. His medication has been reduced 
I to Moditen injections every two weeks and 
Cogentin. His relationship with his family has 
improved and he visits them, but not as often as 
before. Now, he depends more on friends in the 
house and people in the community. 

// ? 

Patient Study No.3 
Tom Brown. 28-years-old. had completed 
Grade 9 and was employed as a laborer. His 
family history was poor. His mother was a 
llanic-depressive, his one brother had been a 
psychiatric patient at Lakeshore and his father 
seemed totally indifferent to his famify's 
problems. Tom also had one sister. 
Over a period of four years, Tom had been 
admitted four times with increasingly severe 
diagnoses of amphetamine psychosis. 
schizophrenia, personality disorders and drug 
abuse. Most recently, he was admitted after 
taking an overdose of Chloral Hydrate tablets, 
his second suicide attempt in a short period of 
time. Although quiet, withdrawn and lethargic, 
he sellled in fairly well on the ward and by late 
June, he no longer felt suicidal. He was closely 
observed by staff for a month. however, and 
was granted limited privileges. 
On admission to the Self-Care Unit in 
November, a psychological assessment 
showed that Tom had marked schizoid 
features, suffered from depression in schizoid 
personality and showed signs of borderline 
schizophrenia. He required intensive individual 
and group relationships that would provide him 
with the support he needed to further his 
independent functioning and rehabilitation. His 
medication included Nozjnan and Cogentin. 
Like many patients coming to the 
Self-Care Unit, Tom lacked self-confidence. 
But in a short time, he seemed comfortable and 
accepting of the emotional support on the Unit 
and he was able to speak up at the daily group 
sessions. He took responsibility for his own 
chores and lent emotional and psychological 
support to his co-patients on the Unit. He 
worked daily in Industrial Therapy, participated 
in social activities in the hospital and 
community and eventually became enrolled In 
an upgrading course in a Community College. 
His relationship with his parents improved and 
he achieved insight into his relationship with his 
brother. who had been upsetting him frequently 
in the past with his problems. 
Tom was discharged In February 1976, to 
a room in the community and until this time has 

remained independent of the hospital except to 
return for a minimum dosage of Moditen. 

In his book, "Reality Therapy," Dr. William 
Glasser states that everyone has two basIc 
psychological needs - "the need to love and 
to be loved, and the need to feel that we are 
worthwhile to ourselves and others.' 
Psychiatric patients for one reason or another 
are unable to fulfill these needs and have 
become irresponsible because they have 
never learned how to meet them. 
In a similar vein, another psychiatrist, Dr. 
Victor Frankl in "Man's Search for Meaning" 
says, "the therapist should increase the 
patient's responsibility. He/she must not 
protect the patient from conflict but show him 
how he may overcome it himself: 
demonstrating that he has untapped reserves 
of strength just as an architect may strengthen 
a decrepit arch by increasing the load upon it, 
forcing the parts more firmly together." 
It is the aim of the Self-Care Unit to help 
the participants in the program develop this 
feeling of responsibility which will enable them 
to give and receive love and to build the 
self-esteem and independence necessary to 
live outside the institutionalized or hospital 
setting. .. 



Patricia Barrington, (R. N., Sf. Mary s School 
of Nursing, Montreal) is presently nursing at 
Lakeshore Psychiatric Hospital in Toronto. In 
July 1975, she developed and organized the 
12-bed S elf- Care Unit which was an offshoot 
of a rehabilitation program using a token 
economy system. In February 1976, the unit 
was expanded to a 45-bed facility. 
Barrington is presently a member of the 
Health Planning CommIttee of the Social 
Planning Council of Etobicoke, Ontario and is 
taking courses towards her degree. 




TIM Canad,an February 1977 

care a 

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The nurse working in emergency is in an optimal position to 
develop a therapeutic relationship with the woman who has 
been raped. The hospital experience can be made a helpful 
one if staff are open, understanding, and knowledgeable in 
their treatment and support of the rape victim. 

the ra 

Sandra LeFort 

If you work in the emergency department of a 
large center, chances are that sooner or later 
you will be called upon to care for a victim of 
rape. In 1974, a total of 1,823" rapes were 
reported to police offIcials in Canada. This 
figure, however, barely skims the surface of 
those who are raped and never press charges. 
Many more victims arrive at a hospital for help 
than these statistics would have us believe. 
Experts estimate that only one rape in ten is 
ever reported. 
Some hospitals in Canada have refused 
outright to treat victims of rape while others 
show varying degrees of cooperation 
depending on the hospital staff involved. In the 
United States, despite nationwide efforts to 
improve the mental and physical care of rape 
victims, the situation is not much better. RN 
magazine (Feb. 1976) reported that many 
private hospitals have a "shut-door policy" for 
rape victims and those who are treated have to 
wait several hours in an emergency room, in a 
state of shock and with little privacy. 
A recent study by workers associated with 
the Montreal Rape Crisis Centre showed that 
78% of hospitals in the Greater Montreal area 
refused to answer a questionnaire concerning 
the protocol used in the care of rape victims in 
their emergency departments. Only 6 out of 13 
hospitals contacted were willing to have rape 
crisis centre workers present inservice 
education to hospital personnel about the 
realities ana myths of rape, the 
medical/nursing care required and legal 
Counsellors at rape crisis centres in 
several cities across Canada, when contacted 
by CNJ, unanimously agreed on one point: the 
emotional crisis that occurs in the life of a 
woman who is raped is often secondary or 
totally ignored by health professionals in their 
initial contact with her. One RCC worker in 
Ottawa described some nurses as "cold and 
matter-of-fact and seemingly unaware of the 
emotional support needed by a woman who 
comes into emergency after being sexually 

e victim 
In emergency 

assaulted." This worker emphasized that what aid emergency room personnel, they have 
is lacking is an informed awareness on the part published a booklet entitled "Emergency 
of nurses about how an assault of this kind Room Care for Rape Victims." The following 
affects the victim's behaVIor. guidelines are excerpts from that booklet._ 
A counsellor at Rape Relief in Vancouver . 
stated: "Overall, the Vancouver medical 
people are fairly good but there are the 
occasional horror stories. Basically, the 
problem is ignorance and insensitivity on the 
part of the medical and nursing staff. What 
they may view as an innocent question i.e. 
'Where were you when it happened?" may sound 
judgmental to the women and be interpreted as 
'They think that it was my fault for being 
there.' We cannot sufficiently emphasize a 
rape victim's need for understanding and 
Societal attitudes are not on the side of 
the rape victim. Often, the prevailing attitude is 
that a woman who is raped had it coming to her; 
she must have done something to provoke the 
attack; she is out to get revenge or else cries 
rape because she is caught in an 
embarrassing situation. For those working In 
the health professions, such attitudes can and 
do prevent the development of helping 
relationships with women who have been 
The woman who has been sexually 
assaulted needs assistance and support. The 
nurse in emergency is in an optimal position to 
use her humanistic skills to decrease the 
victim's fear and anxiety; to help herto be more 
in control of her situation by explaining what is 
happening to her and by listening in an 
understanding way; and to share valuable 
information about counselling services and 
fOllow-up treatment. In an attempt to increase 
knowledge and assist in the development of a 
sensitivity toward the rape victim. the Rape 
Crisis Centre in Toronto is contacting hospitals 
and providing inservice education workshOps 
to staff. As well as providing concrete 
information, sessions also allow for questions 
and discussion about the attitudes and 
feelings the staff have about rape. To further 

In 1975, the Provincial Council of Women 
of Manitoba prepared a Bnef on Rape 
which was supported by the Manitoba 
Registered Nurses Association and the 
Canadian Nurses Association. Among 
others, their recommendations inctuded. 
changing legislation to recognize rape as 
sexual assault; revising courtroom 
procedure; expanding counselling and 
other supportive services: revising 
medical procedures; expanding public 
education; providing treatment and 
counselling services for sex offenders. 
In March 1976, the Criminal Code 
was amended and did incorporate some 
of these recommendations into the new 
legislation, The Justice Department has 
conceded the pOint that moral judgments 
are out of place in criminal courtrooms 
and, correspondingly, limitations have 
been placed on the defense counsel's 
right ta cross-examine women about their 
character and past sexual conduct. Such 
questions may be asked only if the 
information is essential to a fair trial. Other 
amendments give the judge great 
discretionary power. Depending on 
circumstances, the judge may insist that a 
victim's identity be kept secret; that the 
public be excluded from the trial; that the 
location of the tnal be changed - this is 
particularly beneficial for women in small 
Many people, however, feel that the 
recent amendments to the Canadian rape 
laws do not go far enough. In response to 
this criticism, Justice Minister Ron 
Basford has stated that a general revision 
of all sexual offenses within the Criminal 
Code is in process. 

. S/sbs/JCS Canada Ca/alogue numbðr 85-205, annual pubhcabon 
Cnme end TraJ/Jc Enforcement Stebsllcs. 1974 


The Cenedlen Febnary 1977 

Guidelines for Care of 
the Rape Victim 

If emergency room personnel are aware of the 
psychological implications of the rape 
experience, they have an excellent 
opportunity to reassure the victim and to help 
her to regain her equilibrium. If the rape victim 
does not encounter aware and sympathetic 
staff, the hospital procedure will probably only 
further frighten and upset her. Caring for the 
rape victim's emotional state is more than just 
an act of kindness. It is potentially the 
prevention of future psychologic disorders. 

1 . The patient should not be given low 
priority on the grounds that her physical 
injuries are slight. She is frightened, upset, 
possibly exhausted and should be examined 
as soon as possible. This is important for legal 
as well as medical reasons. Specimens should 
be obtained for forensic testing as soon after 
the incident as possible. 

2. If a wait is unavoidable, she should be 
placed in a private room away from the 
embarrassing curiosity of other patients. Any 
unused space can serve this purpose, a 
conference room for example. 

3. She should never be left to wait 
alone. The presence of a supportive and 
sympathetic person is essential. If a rape crisis 
centre is in your community, a caseworker can 
be called by the victim or the nurse to provide 
support at the hospital and to accompany her 
to the police station or her home afterwards. 

4. It is crucial that the nurse display a 
sympathetic, non-critica/, and non- 
judgmental attitude towards the victim. 
Societal attitudes are n(,t on the side óf the 
victim and any attitude \/hich blames her will 
only serve to abort any therapeutic 
relationship. It is inappropnate for medical 
personnel to express any judgments or 
opinions as to whether rape actually occurred 
or whether the victim was at fault. 

5. The offer of small comforts such as 
coffee, kleenex, cigarettes, etc. can be very 
reassuring and may help her feel more at 
ease. She should be kept warm at all times. 

6. Telling her story may be a relief or it 
may be a painful reliving of the incident. In 
either case, she should have to answer 
questions only once, preferably to the nurse 
who remains with her until the medical 
examination. Any attempt to pressure or force 

her into giving details of the incident or 
submitting to the pelvic exam will be 
experienced as a continuation of the violence 
and coercion of the rape. There is no need for 
the woman to relate the entire story to medical 

7. The fol/owing kinds of information 
are relevant: 
- Medical history: menstrual, 
contraceptive, VD history, pregnancies, etc. 
- the time of the alleged assault: whether 
she bathed or douched afterwards. 
- whether penetration occurred or if 
ejaculation occurred elsewhere on her 
- non-genital physical trauma e.g. pain. 
- whether she scratched or injured the 

8. The woman herself has the right tó 
choose the persons she wishes to notify about. 
the incident. She may want to contact the 
police, friends, relatives, or the Rape Crisis 
Centre. The hospital is under no obligation to 
automatically call the police. 

9. All medical examination procedures 
should be explained to the patient in advance. 
Rape victims need emotional support at this 
time. The assurance that the examination is 
happening with her full understanding and 
consent is very important. Rememberthat she 
has just experienced a violation both of her 
body and her right to consent. 
To protect everyone involved, consent 
forms should be obtained from the patient for 
the examination, the collection of specimens 
and the release of evidence to the authorities. 

1 O. If possible a doctor who is sensitive 
to the implications of the rape on her 
emotional state and her family life should 
examine the victim. She may find the 
examination less threatening if it is performed 
by a female doctor. 

phosphatase if indicated 
- pubic and head hair specimens of the 
- other specimens which may be taken 
are anal swabs; dried stains on the skin; 
fingernail scrapings. 
If the woman is not sure whether she 
wishes to report the incident, it is possible to 
store the specimens under refrigeration for 
24-48 hours without contacting the police. 
Specimens sent to the forensic lab should not 
be sprayed or placed in any kind of 
preservative. All samples must be sealed, 
dated and signed by appropriate staff. 
Before and during the medical examination: 
- explain exactly what is is going to 
happen. She is probably very frightened 
and it may be her first internal exam. 
- make sure a woman is present at all 
- do not expose her any more than is 
necessary - provide a blanket. 
- allow her to undergo the internal exam 
in the position which she finds most 
comfortable -lying down or semi-sitting. 
- warm the speculum with warm water 
- try to make her feel as comfortable and 
as calm as possible - it may seem like 
a second rape. 
- if she is reluctant to discuss the 
incident, ask only direct questions 
relevant to her immediate care and to the 
collection of evidence. 

12. In the case of young children, a 
complete internal exam is not necessary. 
Specimens may be obtained with a sterile 
pipette. Many large centres have experienced 
team members who are available to examine 
and counsel sexually assaulted children and 
their parents. 

13. Someone must be available to 
accompany the woman from the hospital to 
her home. It could be a friend, relative, a police 
officer or a rape crisis centre caseworker. If 
she lives alone, suggest that she spend the 
night with family or friends. 

11. It is never necessary for a police 
officer to be present in the examination room 
during any part of the physical exam for legal 
purposes. The examination will include the 14. If the woman appears distraught, it 
collection of specimens: may be advisable to encourage her to seek 
- direct smears from vaginal 
I and professional counselling. She must 
cervix understand, however, that this is simply to help 
- vaginal washings (10 cc normal saline) her deal with a crisis in her life and does not 
for centrifugation and smears and acid imply any underlying neurosis. I 

15. Initial responses to sexual attack 
tend to fall into one or two categories 
--expressed reactions such as crying, 
trembling, nervousness or laughter or- 
repressed reactions such as outward calm, 
and controlled behavior. She may insist that 
there is nothing wrong with her. In many cases, 
the victim with repressed reaction is not 
believed by staff. In one case, a rape crisis 
centre worker observed that a nurse would not 
believe the victim "because she was not 
, crying." 
Studies indicate that approximately an 
equal number of women react in each way. 
r After the initial acute reaction, the victim enters 
a period of withdrawal or repression when she 
simply doesn't want to think about the incident 
at all. It is important for nursing staff to be 
aware of this stage when recommending 
I fOllow-up tests for VD and pregnancy. Unless 
the importance of these tests is impressed 
I strongly on her, she may ignore them as 
reminders of a painful fact she is trying to 

16. The woman must understand the 
need for follow-up treatment. Some form of 
I venereal disease or infection is a possible 
result of rape. She should make appointments 
at the hospital or with her own doctor for tests 
for gonorrhea after three weeks and syphilis 
after twelve weeks. 
Many women worry about becoming 
, pregnant although this actually happens in 
very few cases. If she is at a dangerous point in 
I her cycle, she should be told when and where 
I to get a pregnancy test.4r 

I Suggested Reading 
i 1 Brownmiller, Susan. Agamst Our Will. Men, 
I Women and Rape. New Yo
, Simon and Schuster, 
,2 Burgess, Ann. Crisis and Counselling 
I Requests of Rape Victims, by...and Lynda Holstrom. 
! NursIng Research. 23:3:196-202, May 1974. 
3 Burgess, Ann. The Rape Victim in the 
I Emergency Ward by... and Lynda Holstrom. Amer. 
i J. Nurs., 73:10:1741-5, Oc
. !3. . . 
I 4 Burgess, Ann. Rape: VIctims of O"I51S, by...and 
Lynda Holstrom, Maryland. R.J. Brandy Co., 1974. 
5 Williams, Cindy Cook. Rape: A plea for help in the 
hospitaJ emergency room by... and R. Arthurs. 
Nurs. For. 12:4:388-401, 1973. 

I would lIke to thank the counsellors at the Rape 
Crisis Centres in Vancouver, Ottawa, Toronto and 
Montreal for their cooperation and willingness to 
help in the preparation of this article. A special 
''thank you" goes to the Toronto Rape Crisis Centre 
for their permission to use part of their booklet 
"Emergency Room Care for Rape Vicöms." 


Every nurse has memories buried somewhere of what it was like to be a first 
year student, meeting totally new experiences every day and having to deal 
with them - somehow. And there are patients that we can remember as if it 
were just yesterday. This diary shares the day-to-day 'ups-and-downs' of a first 
year nursing student, and her patient, Mrs. B. 

::yQò . 
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Heather Sproul 
August 3 
Am working afternoons all this week...Light 
was on above 1017, and I walked into the room 
to find a very thin and tiny patient curled up at 
the foot of the bed. She wanted to use the 
bedpan. Noticed that her right arm was 
extended by an armboard held in place by a 
Kerlex. bandage, that was wrapped from her 
hand to her upper arm. She had an IV - and I 
came to the conclusion that the needle must 
have been somewhere in the area of her 
anticubital fossa. 
She was also on a cardiac momtor and 
oxygen by nasal prongs - quite a collection of 
tubes and wires for a little lady. It seemed to 
me that she was a pretty sick cookie. Asked if I 
could have her as my patient the next day. 

. Ker/eK IS a regIstered trademark 01 Kendall Company (Canada) 





August 4 
Mrs. Burton is officially my patient, and I hope 
that I've done the right thing in requesting her. 
I'm pretty sure that I can cope, but time will tell 
if I've bitten off more than I can chew. 
She needs help with meals as she is right 
handed, and refuses to use her left hand. Her 
IV is in her right brachial vein... a rather stupid 
place for it in my opinion, but I guess that 
sometimes it's a matter of putting it wherever 
they can find a vein. 

August 5 
I seem to be coping fairly well with Mrs. Burton. 
Her intravenous is still in her right arm and she 
doesn't appear to be any happier about it. 
Tonight she said that she hates to see her 
supper tray go, because it means that the 
doctors are going to come in and fiddle with her 
IV, and that hurts. When I took her tray away, 
she was almost in tears. 
She seems to be a rather unusual person, 
"spaced out," very flat in her facial expression. 
She always seems preoccupied and doesn't 
have much interest in anything that is going on 
around her. 
She only picks at the food on her tray - 
tonight all she had for supper was tomato juice 
and milk. She says that just the sight of food 
makes her feel ill, and as she eats, a kidney 
basin is her constant compamon. 
I suppose it isn't any wonder that she 
seems apathetic, picks at her food, and 




appears morbidly preoccupied. In my opinion 
her recent medical history must be very I 
discouraging for her. At 63 years of age, Mr
Burton is married, but has no children. Three! 
months ago, she had a massive myocardial 
infarction, and was admitted to the Corona" 
Care Unit at a regional hospital. When her ., 
condition was more stable, she was 
transferred from CCU to a cardiac floor. AboL I 
a week later, she was transferred to Kingstol 
General Hospital and admitted to CCU therf 
with a diagnosis of pulmonary embolism anI 
congestive heart failure. 
By the time I met Mrs. Burton, she had 
been in the hospital for a long time, and hel 
problems were considerable. She was 
diagnosed as having peripheral neuritis, 
congestive heart failure, myocardial infarction 
pulmonary embolism, and leukopenia. I 
August 6 
1945 hours 
Mrs. Burton complained of sharp mid-sterne' 
chest pains. Her blood pressure was 120/65 
pulse 70, and regular. Her face was very pale 
and drawn. Remembered from my reading 
that patients suffering one M I will probably I 
have another, more serious, infarction. I 
figured that she was doing just that, and askec 
the doctor to take a look at her. After his 
examination, the doctor asked me what Mr
Burton had eaten for supper. Then he aske 
me what I thought her problem was. When I 
told him what I thought, he laughed for wha 



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seemed to me to be a long time, told me Mrs. 
,Burton had indigestion, and asked if he could 
Igive her an antacid. He assured me however, 
that I had been right to call him - that it was 
.always better to be on the cautious side. Did 
Imy charting and sat and read Mrs. Burton's lab 
reports until I went off duty. She has had two 
Ibone marrow biopsies done. Will have to do 
'some reading about leukopenia tonight. 

IAugust 7 
IMrs. Burton was asleep when I went into her 
,room for 1600 hour vital signs. I guessed that 
I the lung scan she had earlier this afternoon 
had taken the puff out of her. 
I As Mrs. Burton slept, I began to count her 
respiratory rate. Her breathing was shallow. 
land regular. As I counted, the depth of her 
I respirations increased gradually, and then 
suddenly she stopped breathing for about ten 
I 'seconds, This really threw me. I thought that 
she'd had a respiratory arrest, until her 
breathing began again, shallow and regular. 
For a few minutes, she followed the same 
I pattern ... Cheyne -Stoking? This time I decided 
to talk to my instructor before I called a doctor. 
I Quiet after supper. Mrs. Burton was 
I napping, so I read more of her chart. Still no 
i word on the cause of her leukopenia. 
At report this afternoon, our instructor 
I suggested that if we had any spare time this 
evening, we should look up Valium in the 
I C. P.S., as it is the most widely prescribed drug 
I in the world, and just about all the patients on 
the floor are taking it. Mrs. Burton has been on 
Valium since the beginning of her illness. So, 
when I'd finished with Mrs. Burton's chart, I 
decided to tackle theC.P.S. and Valium. There 
it was on page 222 - the mOre senous 



adverse reactions occasionally reported are 
leukopenia"... hmmm. 
Went to my instructor with my findings and 
she suggested that I talk to one of the doctors 
about it. The doctor seemed to think that I had 
taken leave of my senses, and informed me 
that Valium-induced leukopenia is extremely 
rare (why can't Mrs. Burton have a rare case of 
Valium-induced leukopenia?)...Crushed. 

1950 hours 
Again, Mrs.Burton complained of sharp 
mid-sternal chest pains. She looked like death 
warmed-over. Decided to play it cautious 
again and have a doctor take a look at her. He 
gave her one nitroglycerine sublingually and 
Mrs. Burton settled down in aboutfive minutes. 
Earlier in the evening, I had placed Mrs. 
Burton in the textbook position for a person 
with dyspnea. But when the doctor came in, his 
first comment to me was that she was likely to 
smother in all those pillows. So much for my 
positioning skills. 
My last evening. Next week, /11 be on days 
and Mrs. Burton will need a bed bath. With two 
IVs, cardiac monitor wires, and oxygen in the 
way, one of us is bound to get hanged. We'll 

August 10 
At report this morning, found out that Mrs. 
Burton needs a nose and throat swab to be 
sent for culture and sensitivity. This should be 
no problem tor me as I've done swabs before 

in microbiology labs. Plan on doing the swabs 
before breakfast along with eight o'clock vital 
Swabs went without a hitch. So did the 
bed bath, Mrs. Burton was taken off the 
cardiac monitor sometime over the weekend, 
so that meant one less set of cords for me to 
worry about. Noticed reddened area just below 
her coccyx. I'd better get out the brown soap 
and try better positioning too. (I take the 
weekend off, and the place falls apart). 
Mrs. Burton is still pretty lethargic and has 
no interest in what's going on around her. 
Thought last week that it might be because of 
the day's activities, but now I'm more inclined 
to think that it's due to the long period of time 
she s been in hospital. 
Felt that I was doing a fairly good job with 
Mrs. Burton until I read her chart this morning 
The psychiatric resident was down to evaluate 
Mrs. Burton yesterday. He found her to be 
deteriorating mentally, slow, demented, and 
unkempt. III admit that Mrs. Burton s hair is 
disheveled - it's short, she s between perms. 
and she's having oxygen by nasal prongs. The 
psychiatrist is scheduled to see her tomorrow, 
so I'm going to try to improve her appearance 
with a snappy new hairstyle before he sees 

August 11 
Things were going fine with Mrs. Burton until 
breakfast arrived - her IV had gone 
interstitial, so one of the doctors decided to 
remove it and restart it after Mrs. Burton had 
finished breakfast. Mrs. Burton s toast was 
ice-cold so I toddled off to make her some 
more. Got back to tind that her IV had sprung a 
leak - blood all over the bed, pouring out from 
her IV site. Grabbed a couple of 4 x 4's, applied 
pressure and elevated her arm. Realized that 
Mrs. Burton is on heparin therapy and that 
she'll take her own sweet time to clot. During 
all of this, Mrs. Burton was munching away on 
her toast, happy as a little clam. 
Got the bleeding stopped. Took her tray 
away and came back in time to see Mrs. 
Burton's breakfast coming back up. All in all, 
she vomited 100 mls ot undigested food. 
Guess she was pretty worn out at this point - 
she practically begged me to let her rest tor 
half an hour before I gave her her bath and did 
her hair. Fifteen minutes later, guess who 
walks into Mrs. Burton's rOom - the 
psychiatrist and his band of interns and 
residents (I just can't get ahead!!). 
My instructor and I sat in on his 
consultation. Learned a lot about interviewing 
trom watching the psychiatrist - he has the 
best technique that I've ever seen - he keeps 
the whole interview very open-ended, doesn't 
appear to be rushed and asks very few 
questions, lets the patient do just about all of 
the talking. In the huddle outside Mrs. Burton's 
door afterwards, he stated that she did not 
appear to be deteriorating mentally at all, but 
was probably just frustrated with her 
prolonged stay in hospital. He prescribed 
home fOr her just as soon as her physical 
condition would allow it. What a load off my 

August 12 
First half of this morning was relatively 
uneventful. That brown soap and massaging 
really works - the red spot on Mrs. Burton's 
coccyx has disappeared. She had no 
problems with breakfast today. 
At about 1100 hours, she said that she 
wanted to use the commode chair. After about 
fifteen minutes on the chair, her light went on. 
Mrs. B. announced to me that nothing was 
happening and that she wanted an enema or 
suppository or else she was going to faint. Told 
her I'd check with one of the nurses and let her 
know what the verdict was. A nurse suggested 
that Mrs. Burton sit on the commode for 

another fifteen minutes. Fifteen minutes later, 
Mrs. Burton stated that if I didn't give her an 
enema or suppository, that she would faint! (a 
fact which wouldn't surprise me at all). 
The nurse told me that since Mrs. Burton 
was so determined, it might be best to ask her 
doctor for a glycerine suppository. So, I got to 
give my first suppository. and Mrs. Burton got 

August 13 
Decided today to get one of the other students 
to help me and between the two of us we'd 
wash and set Mrs. Burton's hair. Found out 
while we were washing it (in bed) that it hadn't 

Sometimes, baby gets 
more air than formula. 



That's why we make soothing, 
peppermint-flavoured Ovol 
Ovol is simethicone, an 
effective but gentle antiflatu- 
lent that relieves trapped air 
bubbles in baby's stomach and 
bowel without irritating gastric 
Ovol works fast. And that's a 
rei ief for baby. And for mother. 

Also available ,n adult-5trength 
chewable tablets. 





11 . 


"" . 



been done for seven weeks. Greta set Mrs 
Burton's hair while I gave her a bath and thE 
two of us got her sitting up in her chair with tt 
hair dryer. Changed her bed and tidied up tho 
room. Was time for lunch at this point, so WI 
combed Mrs. Burton out and put on her 0\\ 
nightgown and bathrobe before bringing he 
tray in. Quite a change - Mrs. Burton glowed 
Just after hertray was brought in, her husban 
and sister dropped by to see her. I just couldn I 
believe myeyes-Mrs. B. not only showed a , 
interest in things but ate just about all of hE' 
lunch (it stayed down, too). 
August 17 
Back on afternoons this week. Mrs. Burton r 
really showing improvement. She asked m,l 
what I did to keep out of trouble last weeken( ! I 
Her chart says that she can be ambulate, 
in her room with assistance, so maybe afte 
supper, the two of us will go tearing around hE 
Always figured that Mrs. Burton was 
about four foot nothing in her stocking feet 
Was ql,lite surprised to find that when she g 
up out of bed that she's really a lot closer to fi" I 
foot six. She didn't tolerate the rip around h 
room too well- felt dizzy and short of breatl 
-'probably partly because she's been in bE 
for so long. Maybe she'll do better tomorro 
August 18 
Mrs. Burton made it around her room twiCE 
tonight! She still needs a lot of assistance ar 
encouragement but she didn't get really tire 
until halfway through the second lap. 
Tomorrow night I'm going to try to get her 
walk out in the hall. 
August 19 II 
Made it all the way up to the door of the CC 
with Mrs. Burton tonight. She's beginning t 
tolerate ambulation quite well and In no time. 
all, she should be roaring up and down thE 

August 20 
Came on duty this afternoon to find Mrs. 
Burton's room empty - she was discliargl 
this morning. She's gone, and I'm really goir 
to miss her. She was an interesting lady, an. 
really leamed a lot from her. Thanks alot, MI 

Author's note: Heather A. Sproul is current I 
a second year nursing science student at 
Queen's University, Kingston, Ontario. She 
wrote this article during the clinical 
intersession of her first year. She is intereste 
in specializing in orthopedics or burn therB{. 
upon graduation. 

1 Luckman, Joan. Medical-surgical nursmg, 
psychophysiologic approach, by... and Karen I 
Creason Sorensen. Toronto, Saunders, 1974. 
2 Canadian Pharmaceutical Association. 
Compendium of pharmaceuticals and specialti 
ged. Toronto, 1976. p. 222. 

him drier 

\ . 



"Oll tillle 
Pampers construction 
helps prevent moisture 
from soaking through 
and soiling linens. As a 
result of this superior 
containment, shirts, 
sheets, blankets and 
hed pads don't have to 
be changed as often 
as they would with 
conventional cloth 
diapers. And when less 
time is spent changing 
linens, those who take 
care of babies have 
more time to spend on 
other tasks. 

Instead of holding 
moisture, Pampers 
hydrophobic top sheet 
allows it to pass 
through and get 
<<trapped" in the 
absorbent wadding 
underneath. The inner 
sheet stays drier, and 
baby's bottom stays 
drier than it would in 
cloth diapers. 


... .., -.











Essentials of Communicable 
Disease, 2ed. by Mary Elizabeth 
Mcinnes. 401 pages. The C. V. 
Mosby Company, SI. Louis, 
1975. Canadian agent: Mosby, 
Approximate price $10.00 
Reviewed by Christina Gow, 
Assistant Professor, School of 
Nursing, UniversIty of British 
Columbia, Vancouver, British 

The author's suggestion that this 
book could be used as a quick 
reference is, in the reviewer's mind, a 
correct one. The text's contents cover 
a wide range of material, beginning 
with an introductory section which 
deals with such topics as historical 
events, scope of control, immunology, 
social, psychologic and economic 
factors, jet-borne communicable 
diseases, care of patients with 
communicable diseases and rashes. 
This section is very general and 
somewhat repetitious. Reference 
material dating from the early and 
mid-sixties is not very current as the 
book was published in 1975. The 
author has attempted In this 
introductory section to present 
material in an interesting way. One 
problem involved in such a broad 
introduction is the sheer bulk of 
material available. 
The author then divides the text 
into sections dealing with the specific 
diseases of varied causes: 
Section II deals with Bacterial 
Diseases: Part A - Infectious 
Diseases and Part B - Enteric 
Diseases. This classification is 
confusing, as both Part A and B 
diseases are highly communicable, 
eg., Tuberculosis (Part A), Typhoid 
Fever (Part B). In this section. 
references cited are again often from 
the sixties; in one instance(dealing 
with tuberculosis) the author referred 
to a 1959 reference on the 
effectiveness of chemotherapy. 
Section III deals with Viral 
Diseases. A table is presented on 
page 222 which outlines the 
classification of viruses, but no 
reference is cited. This introduction 
would have been more beneficial had 
some of the types of viruses been 
further explained. More detailed 
information would help the beginning 
reader, although the book does not 

claim 'exhaustive coverage.' A further 
suggestion is that the glossary could 
have been more detailed. 
Sections IV, V, and VI deal with 
Arthropod-borne diseases, diseases 
caused by fungi, and Helminth 
infections. The information in these 
sections is of use for quick reference. 
The treatment sections under 
each of the diseases are not up to date 
in all cases eg.: with Scarlet Fever it is 
stated "bed rest is mandatory for one 
This text would be useful to 
student nurses as a reference guide 
and not as a basic textbook. The writer 
has attempted to cover many 
diseases and has presented a source 
which will be of use as a beginning 
reference for the nurse. 

Diagnostic Procedures. A 
Reference for Health 
Practitioners and a Guide for 
Patient Counseling by Barbara 
Skydell, R.N., M.A. and Anne S. 
Crowder, R.N., M.A., Little, 
Brown and Company, Boston, 
Reviewed by Lou Lewis, R.N., 
M.Sc.N., Instructor, Nursing 
Department, Ryerson 
Polytechnicallnstitute, Toronto, 

This book provides a quick and 
easy reference for health 
professionals who prepare patients 
daily for various diagnostic 
procedures. It emphasizes the need 
for creative patient teaching regarding 
diagnostic tests, and for 
communication with the patient so that 
he will know what to expect before, 
during, and after an unfamiliar 
The book is divided into twelve 
sections. The first section is an 
overview which deals with an 
approach to commUniCation, and 
explains the format of the book. It also 
discusses such factors as time, 
patient attire, consent and diet that are 
common to successful completion of 
many diagnostic tests. 
The next ten sections of the book 
discuss the diagnostic procedures 
themselves. The tests outlined include 
those used in neurology, 
opthalmology, urology, the biliary and 

gastrointestinal systems, 
cardiovascular and respiratory 
systems, and female reproductive 
system. Also included are 
radioisotope scanning, ultrasound 
and additional procedures. Each 
procedure described follows a similar 
formal. It includes purpose, time, 
location, personnel, equipment, 
technique, preparation, patient 
sensations, and aftercare. The book 
covers the most commonly performed 
procedures and those for which health 
personnel most often prepare 
A positive feature of this book is a 
listing of sensations the patient may 
experience as well as points to 
remember in the aftercare of the 
patient following each specific 
. This book should be used as a 
basic, handy reference for health 
professionals. It is not designed as a 
definitive reference on either a 
procedure or its diagnostic 
implications. Rather, it should be most 
helpful as an immediate source of 
basic information for patient 
instruction. It could be a helpful 
resource for students and 

Maternal Health Nursing 
Review. by Josephine Evans 
Sagebeer. New York, Arro 
Publishing Company, Inc., 1975. 
Approximate price $6.00. 
Reviewed by Patty Ellis, School 
of Nursing, Faculty of Health 
Sciences, McMaster University, 
Hamilton, Ontario. 

The purpose of the ARCO 
Nursing Review Series, and more 
specifically the Maternal Health 
Nursing Review, is to provide nurses 
and nursing students with a 
comprehensive review of a specific 
nursing subject, in this instance 
maternity nursing. This is done 
through multiple choice questions plus 
a few matching questions with 
answers and brief explanations given 
at the end of each chapter. Each 
chapter looks at a different area of 
maternity care so that there is 
complete coverage of the subject. The 
questions and their answers are 
documented as to their original 
source. The reader is then able to 

authenticate all of the material 
presented if she/he so desires. 
The book is certainly 
comprehensive in its factual coverage 
of maternity nursing, of both normal 
and abnormal cases and can be used 
for examination preparation and 
continuing education. 
It does, however, have several 
limitations. First, many questions 
dealing with either statistics or history 
are irrelevant for Canadians as the 
information given is American. 
Another limitation is the quality of the 
questions themselves. Most of the 
questions require only memorization 
of facts. Very few of them require 
thinking on the part of the reader. 
In addition, the technique of 
writing good multiple choice questions 
has not always been applied as many 
errors can be noted in the questions 
themselves. For example, the use of 
"all of the above" or "none of the 
above" as distractors is fairly common 
throughout the book. Other questions 
deal with useless information such as 
asking how many maternal deaths 
there were in 1963 (page 11, question 
27). The final limitation is that the 
material presented is a review of 
textbook information which is often 
outdated due to the time process 
involved in publication 
Despite the limitations, the book 
is thorough in its coverage of maternity 
nursing as this subject is presented in 
the present textbooks. As long as the 
reader is aware of the limitations, the 
book can accomplish its purpose of 
aiding with the education of nurses 
and nursing students. 

Did you know ... 
Why do couples risk conception, even 
though they definitely do not want a 
baby? This question, recognized as 
central to utilization of contraception, 
was the principal theme of a 
symposium taking place at the Ontario 
Science Centre in Toronto late in 
1975. The proceedings of the 
symposium are recorded in an 
informative and stimulating booklet 
An Exploration of the Limitations of 
Conception. Single copies of the 
64-page booklet are available without 
charge to those interested from 
Department of Public Affairs, Ortho 
Pharmaceutical (Canada) Limited, 19 
Green Belt Drive, Don Mills, Ontario. 



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il)l.ttl.U lTI)dtlte 

Publications recenlly received In the 
Canadian Nurses' Association Library 
are available on loan - with the 
exception of items marked R - to 
CNA members. schools of nursing. 
and other institutions. Items marked R 
include reference and archive material 
that does not go out on loan. Theses, 
also R, are on Reserve and go out on 
Interlibrary Loan only 
Requests for loans maximum 3 
at a time, should be made on a 
standard Interlibrary Loan fOlm or by 
letter giving author, title and Item 
number in this list. 
If you wish to purchase a book, 
contact your local bookstore or the 

Books and documents 
1. Anderson, Carl Leonard. School 
health practice, by... and William H 
Creswell. 6ed. St. Louis, Mosby, 1976. 
2. Argelander. Hermann. The initial 
interview in psychotherapy. New 
YOfk, Human Sciences Pr., c1976. 
3. Ashley. JoAnn. Hospitals, 
paternalism. and the role of the nurse. 
New York, Teachers College Press. 
c1976 158p. 
4. Auerbach, Stevanne. Rationale for 
child care services - programs vs. 
politics, edited by.. with James A. 
Rivaldo. New York, Human Sciences 
Pr., c1975. 215p. 
5. Billing, Doris HM. Practical 
procedures for nurses. 2ed. London, 
Baillère Tindall, 1976. 157p. 
6. Capell, Peter 1. Ambulatory care 
manual for nurse practitioners. by... 
and David B. Case. Philadelphia, 
Lippincott, c1976. 333p. 
7. Compliance with therapeutic 
regimens, edited by David L. Sackett 
and R. Brian Haynes. Baltimore, John 
Hopkins UniversIty Pr., c1976. 293p. 
8. Conference of Ministers 
Responsible for Health. 2nd meeting, 
Plymouth. Montserrat, July 12-15, 
1976. Final Report. Georgetown, 
Guyana. Caribbean Community 
Secretariat, 1976. 50p. 

9. Conference on Long-Term Health 
Care Data held at Tucson, Arizona, 
May 12-16, 1975. Long-term care 
data. Toronto, Lippincott, 1976. 233p. 
10. Conference on Teacher 
Education, Vancouver, B.C., May 5-7. 
1975 Contmumg education for 
teachers - issues and strategies. 
Proceedings. Ottawa, Canadian 
Teachers' Federation. 1976. 179p. 
11. Dixon, Eileen P. An introduction to 
the operating theatre. Edinburgh, 
Churchill Livingstone, 1976. 51p. 
12. Dodson, Burt. Strategies for 
clinical engmeering through shared 
services, by...and Ben W. Latimer 
Battle Creek, Mi., w.K. Kellogg 
Foundation, 1976. 72p. 
13 Health education for the public. A 
statement of public policy. 
September 1976. Prepared by the 
State Health Planning Advisory 
Council and the Office of Health and 
Medical AffaIrs. Lansing, Mich., 1976. 
14. Infant nutrition, edited by Doris H 
Merritt Stroudsburg. Pa., Dowden, 
Hutchison & Ross, c1976. 431p. 
15 International Seminar on Nursing 
Legislation, Bogota, Colombia, June 
9-19. 1974 Nursing legislation in 
Latin America: the last half of the 20th 
century. Geneva, International 
Council of Nurses, 1975. 109p. (ICN 
Publication no. 5) 
16. Mahoney, Elizabeth Anne. Howto 
collect and record a health history, 
by... Laurie Verdisco and Lillie 
Shortridge. Philadelphia, lippincott, 
c1976. 133p. 
17. Martinon, F. L'infirmiére en 
chirurgie digestive. Paris, Expansion 
scientifique française. 1976. 132p. 
18. Materiel didactique. edite par 
Rollande Gagne. Montreal, 
Intermonde, 1975. (loose-leaf) Iv. 
19. Morton, Barbara M. VD: a guide for 
nurses and counselors Boston, Little, 
Brown and Co., c1976 218p. 
20. Munneke, Leslie E. Motivation 
through management. Swarthmore, 
Pa., Personnel Journal, c1968. 114p. 
21 National League for Nursing. 
Instructor accountability: issues, 
facts, impact. New York, c1976. 208p. 
(NLN Publication no. 16-1626) 
22.-. Strategies in administration 
and teaching in associate degree 
nursing education. New York, c1976. 
66p. (NLN PublicatIon no. 23-1630) 

23.-. Division of Research. 
State-approved schools of nursing 
LP.N./LV.N. 1976. New York, 1976. 
24. Niswander, Kenneth R. 
Obstetrics: essentials of clinical 
practice. Boston, Little. Brown and 
Co , c1976. 520p. 
25 Nutrition in preventive medicine: 
the major deficiency syndromes, 
epidemiology, and approaches to 
control, edited by G.H. Bealon and 
J.M. Bangon. Geneva. World Health 
Organization. 197Ð. 590p. (WHO - 
monograph series no. 62) 
26. L'Ordre des Infirmières et 
Infirmiers du Québec. Priorites 
1976-77 Montreal, 1976. 70p. R 

27. Organisation Mondlale de la 
Sante. Documents fondamentaux. 
Genève, 1976. 1 v R 
28. -L'élement sante dans la 
protection des qrOits de I'homme, I 
face aux progres de la biologie et de J 
la medecine. Genéve, 1976. 50p 
29. Pan American Sanitary Bureau. 
Report to the director. 1975. 
Washington, 1976. 176p. 
30 Pluze, Suzanne. La sante par Ie 
yoga. Montréal, Editions du Jour, I 
c1967. 134p. 
31. Promoting health: consumer I 
education and national policy, edited 
by Anne R. Somers. Germantown, I 
Md., Aspen. c1976. 264p. I 
32. Seguy, Bernard. Garçon ou fille à 
votre choix. Paris, Editions I 
Intermedica, 1975. 171 p. 





"No you can't offer your mother-in-Iaw's heart to science unless she 
agrees. . . .. 

Charting progress in nursing care 

SAll\"É & PECHERER: Concepts and Skills in 
Physical Assessment 
This book can save you valuable time in teaching yourself the basics 
of physical examinations. Irs a modular syllabus for self-study (with 
instructor guidance). Each of its 23 units includes a pIe-test, glos- 
sary, clinical component, a self-test. response sheets, and handy 
reference cards for use during actual examinations. An Instructor's 
Guide will be available. 
By Mary Jane Sauve, RN. BSN. MSN. Calif. State College. Sonoma. Rohnert 
Park; and Angela R. Pecherer, RN. BSN, MSN. Intercollegiate Center for 
Nursing Education. Spokane, Wash. About 415 pp. IIlustd. Soft cover. About 
$11.30. Ready Feb. 1977. Order #7939-0. 

Dorland's Pocket Medical Dictionary, 
New 22nd Edition 
Completely up-dated, this 22nd edition has been developed under 
the editorial supervision of 84 internationally recognized authorities 
in medicine and the health sciences. It presents a wealth of new 
definitions, and a thorough revision of existing terms to conform with 
today's most accepted medical knowledge and usage. Obsolete 
terms have been deleted. The dictionary includes 16 color plates, 
and a helpful list of word elements from classical roots. 
About 850 pp. lIIustd., 16 color plates. Ready March 1977 Order #3162-2 

GUYTO:'\: Basic Human Physiology: Normal 
Function and l\lechanisms of Disease, 
"Jew 2nd Edition 
Ideal for the study of nursing physiology, Guyton's Basic Human 
Physiology presents the same concepts and principles as in Guyton's 
Textbook of Medical Physiology, but it omits most of the references 
to research work. many of the special qualifying explanations, and 
some of the references to clinical problems. Up-dated throughout, 
the sections on the kidneys, the nervous system, and the endocrines 
in particular, have been thoroughly reworked. 
By Arthur C. Guyton, MD, Unlv. of Mississippi School of Medicine. Jackson. 
About 930 pp.. 420 III. About $17.00. Just Ready. Order #4383-3. 

ì\.: Current Therapy 1977 
Conn-the one therapeutics book that belongs in every reference 
library-presents the core of clinical medicine in a nutshell. New '77 
articles include: herpes gestationis. pseudofolJiculitis Barbae, and 
papular dermatitis. It also reports new therapies for diabetes insipi- 
dus, herpes simplex, Hodgkin's disease. cardiac arrhythmias, 
leukemias, urinary infections, asthma, and hundreds of other 
Edited by Howard F. Conn, MD; with 14 con"ulting editors; and 342 con- 
trrbutors. About 995 pp. About $24.75. Ready Feb. 1977. Order #2662-9. 

The Nursing Clinics of NOI"th America 
These quarterly symposia keep you informed on the most important 
changes in clinical nursing practice. The March 1977 issue focu_es 
on Peripheral Vascular Disease with Dorothy l. Sexton-guest 
editor; and on The Minority Patient: Cultural and RacIal C.I/versity. 
Other 1977 symposia will discuss: Primary Nursing; Diseases of the 
Liver; Patterns of Parenting; Diabetes; and other vital nursing topics. 
By respected nursing authorities. Published quarterly: March, June, Sept., 
and Dec. Hardbound. Contains no advertising. Averages 185 pp. lIIustd. 
$18.90 per year's subscription. (Subscriptions can be obtained ata saving of 
$1.60 by sending a check for $17.30 a,..)Og with your subscription request ) 
Order #0003-3. 

ASPERHEI:\I & EISENHAUER: The Pharmacologic 
Basis of Patient Care, Nen' 3rd Edition 
In this comprehensive revision, you'll find much new data including 
expanded discussions of drug-drug and drug-food interactIOns. 
hyperalimentation. content of the problem-oriented record and drug 
therapy, steroid drug therapy, and drug administration to pedIatric 
patients. It's thoroughly up-dated, and a new Instructor's Guide will 
be available too. 
By Mary K. Asperheim, MD, Medical Univ. of South Carolina; and Laurel A. 
Eisenhauer, RN, MSN, Boston College School of Nursing. About 575 pp. 
IIlustd. About $11.10. Ready March 1977 Order #1437-X. 

KEANE: Saunders Review for Practical Nurses, 
Xew 3rd Edition 
Designed to prepare the student for state board examinations, this 
outline review covers the entire course content of practicall 
vocational nursing. All units have been carefully brought up to date 
in this revision, and a unit on patient assessment has been added. 
The section on Nursing the Mother and Her Newborn Infant is com- 
pletely rewritten. Blank IBM answer sheets, and a key to the correct 
answers are provided. 
By Claire Brauckman Keane, RN, BS. MEd, College of Education, Univ. of 
Georgia, Athens. About 510 pp., 155 ill. Soft cover. About $7.75 Ready 
March 1977. Order #5327-8. 

FORD!\:EY: Insurance Handbook for the 
Medical Office 

If processing insurance claims is one of your non-clinical respon- 
sibilities, this authoritative worktext shows you how to change that 
job from a frustrating chore into a simple procedure. All aspects of 
handling claims efficiently and without error are covered including: 
computerized billing; collecting on unpaid accounts, knowing the 
simplest form to use; CanadIan health Insurance,- etc. A Teacher's 
Guide is available. 
By Marilyn Takahashi Fordney. CMA-AC. Ventura College. California. About 
350 pp. lIIustd. Soft cover. Ready March 1977. Order #3811-2. 




r CANADA LTD. P"ces sublectto change 



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l..jil),ell,eu lT 1 )(lllte 

The Canadian Nurse February 1977 

33. Shephard, Roy J. Endurance 
fitness. Toronto, University of Toronto 
Press, c1969. 246p. 
34. Smith, lola. Assessment of a 
demonstration project on continued 
follow-up nursing visits to colostomy 
patients. Toronto, Victorian Order of 
Nurses for Canada, 1976. 117p. 
35. Symons, T.H.B. To know 
ourselves. The report of the 
Commission on Canadian Studies 
volumes 1 and 2. Ottawa, Association 
of Universities and Colleges of 
Canada, 1975. 115p. 
36. Thompson, Eleanor Dumont. 
Pediatrics for practical nurses. 3 ed. 
Philadelphia, Saunders, 1976. 378p. 
37. American Nurses' Association. 
Research in nursing: toward a 
science of health care. Kansas City, 
Mo., 1976. 15p. 
38. Atlantic Institute of Education. 
Hospitals are for learnmg. Halifax, 
1976. 47p. 
39. Bassett, I. Canadian havens from 
hay fever, by... C.w. Crompton and C. 
Frankton. Ottawa, Canada Dept. of 
Agriculture, 1976. 23p. 
40. Burton, Charles. Gravity lumbar 
reduction therapy program, by... and 
Gail Nida. Minneapolis. Mn., Sister 
Kenny Institute, c1976. 20p. 
41. Clarke Institute of Psychiatry. 
Report, 1975. Toronto. 
42. College of Nurses of Ontario. 
Standards of nursing practice: for 
registered nurses and registered 
nursing assistants. Toronto. 1976. 
43. The employment interview - 
techniques of questioning. 
Swarthmore, Pa., The Personnel 
Journal, 1974. 16p. 
44. Foundation Center. The 
foundation directory, supplement 3. 
New York, Columbia University Press, 
1976. 24p. R 
45. Lenburg. Carrie, B. Criteria for 
developing clinical performance 
evaluation. New York, National 
League for Nursing, c1976. 16p. (NLN 
Publication no. 23-1634) 
46. Milner-Fenwick Inc. 1976 film 
catalog: health education, medicine, 
dentistry. Baltimore, Md., 1975. 
Distributed by Canfilm Media, 
Willowdale, Ont. 27p. 

47. National League for Nursing. 
Patient education. New York, c1976. 
38p. (NLN Publication no. 20-1633) 
48.---:. Your career in nursing. New 
York, 1976. 16p. (NLN Publication no. 
49.-. Dept. of Baccalaureate and 
Higher Degree Programs. 
Baccalaureate education in nursing: 
key to a professional career in nursing 
1976-77. New York, 1976. 25p. (NLN 
Publication no. 15-1311) R 
50.-. Masters education in nursing; 
route to opportunities in 
contemporary nursing 1976-77. New 
York, 1976. 25p. (NLN Publication no. 
15-1312) R 
51.-. Dept. of Diploma Programs. 
Education for nursing - the diploma 
way 1976-77. New York, 1976. 27p. 
(NLN Publication no. 16-1314) R 
52. Nursing home administration; a 
reader consisting of ten articles 
especially selected by The journal of 
nursing admimstration editorial staff 
Wakefield, Ma., Contemporary, 
c1976. 43p. 
53. Ogg, Elizabeth. Unmamed 
teenagers and their children. New 
York, Public Affairs Committee, 
c1976. 28p. (public affairs pamphlet 
no. 537) 
54. Order of Nurses of Quebec. 
Nursing in prolonged care. Montreal, 
55. L 'Ordre des Infirmières et 
Infirmiers du Québec. Nursing en 
soins prolongés. Montréal, 1976. 44p. 
56. Quality assurance; scripts from a 
series of tapes developed for nursing 
dial access. Madison. Wi., University 
of Wisconsin - Extension, Health 
Sciences Unit, Dept. of Nursing, 1975. 
57. Registered Nurses' Association of 
Ontario. Guide to qualifications and 
responsibilities of registered 
personnel in nursing service. Toronto, 
1976. 25p. 

The 1976 Index for 
The Canadian Nurse, 
vol. 72, is available on 
request. Write to 
The Canadian Nurse, 
50 The Driveway, 
Ottawa, Ontario, 
K2P 1 E2. 

58. Reynolds, Barbara. The nurse as a 
change agent. New York, American 
Association of Industrial Nurses. 
1976. 5p. 
59. Sackett, David L. The 
development and application of 
indexes of health I: general methods 
and a summary of results, by... et al. 
Hamilton, Ont., McMaster University, 
1976. 23p. 
60. Saltman, Jules Marijuana: current 
perspectives. New York, Public 
Affairs Committee, c1976. 28p. 
(Public affairs pamþhlet no. 539) 
61. Saskatchewan Registered 
Nurses' Association. Guidelines for 
implementing a quality assurance 
program. Regina, Sask., 1976. 9p. 
62. Scholarships and loans for 
beginning education in nursing. New 
York, National League for Nursing, 
1976. (NLN Publication no. 41-410) 
63. Smith. E.S.O. Family planning 
programs in Britain, West Germany 
Denmark and Sweden, with 
implications for Canada. Edmonton. 
Alberta Social Services and 
Community Health, 1975. 15p. 
64.-. Venereal disease programs in 
Britain, West Germany, Denmark and 
Sweden, with implications for 
Canada. Edmonton. Alberta Social 
Services and Community Health, 
65. The techniques of nursmg 
management, volume two; a reader 
consisting of eleven articles 
especially selected by The journal of 
nursing administration editorial staff. 
Wakefield, Ma., Contemporary, 
c1976. 46p. 
66. Victorian Order of Nurses for 
Canada. Charter and by-laws 1976. 
Toronto, 1976. 33p. R 
67. Zohman, Lenore R. Beyond diet... 
exercise your way to fitness and heart 
health. New York, CPC International, 
1974. 36p. 

Government documents 
68. Bibliothèque sClentifique 
nation ale. Répertoire de la recherche 
subventionnée dans les universités 
Ottawa, Conseil national de 
recherches du Canada, 1976. 2v. R 

69. Comité consultatif national des 
Services de Santé. Premier rapport 
présente au Commissaire du Service 
Canadien des Pénitenciers. Ottawa, 
Solliciteur général Canada, 1974. 
70. Conseil national de recherches 
Canada. Direction de l'information 
publique. Programmes audio-visuels. 
Ottawa, 1976. 1 v. 
71. Health and Welfare Canada. A 
parent's guide to drug abuse. 3ed. 
Ottawa, Minister of Supply and 
Services, 1976. 26p. 
72. Health and Welfare Canada. 
Advisory Committee on Food Safety 
Assessment. Report. Ottawa, 1975. 
73.-. Health Insurance Directorate 
Health Programs Branch. Emergency 
services in Canada, v.5: architectural 
aspects of emergency services. 
Ottawa, 1975. 1v. 
74.-. Health Protection Branch. 
Canadian trends in smoking related 
diseases: lung cancer mortality. 
Ottawa, 1976. 16p. 
75.-. Nutrition Division. Healthful 
eating. Ottawa, Supply and Services, 
1976. 71 p. 
76. Labour Canada. Wage rates, 
salaries and hours of/abour, 1975. 
Ottawa, Supply and Services Canada, I 
1976. 1v. 
77. National Health Services Advisory 
Committee. First report to the : 
Commissioner of the Canadian 
Penitentiary Service. Ottawa, Solicitor 
General Canada, 1974. 29p. 
78. National Research Council of 
Canada. Public Information Branch. 
Audio-visual programs. Ottawa, 
1976. 1v. 
79. National Science Library. 
Directory of federally supported 
research in universities 1975-76. 
Ottawa, National Science Library, 
National Research Council of 
Canada, 1976. 2v. R 
80. Revenu Canada. Les rouages de 
/'impOt. Ottawa, Information Canada, 
1975. 69p. 
81. Revenue Canada. Inside taxation. 
Ottawa, Information Canada, 1975. : 
69p. I 
82. Santé et Blen-être social Canada. : 
Guide des parents sur /'abus des 
drogues. éd. 3. Ottawa, Ministre des 
Approvisionnements et Services I 
Canada, 1976. 28p. 


R f. JOr\NSON 

No. 169 


\ \\ 

No. 100 

N No. 170 
. , . 
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Six smootl1 plastic cards 31,)" x 
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":e gtoU\lll ift 

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Card No., EXplratLon Date and your signature 







The Canadian February 1977 

o · 

Slow-At folic. 
(ferrous sulfate-folic acid) 
hematinic with folic acid 

The new Posey products shown 
here are but a few included in the 
complete Posey Line. Since the 
introduction of the original Posey 
Safety Belt in 1937, the Posey 
Company has specialized in 
hospital and nursing products 
which provide maximum patient 
protection and ease of care. To 
insurf! the original quality product, 
always specify the Posey brand 
name when ordering. 
The Posey "Swiss Cheese" Heel 
Protector has 
 hook and eye 
fasteners for easy application and 
sure fit. Available in convoluted 
porous foam or synthetic fur lin- 
ing. #6121 (fur lining), 16122 


The Posey Foot Elevator protects 
pressure sensitive feet by keeping 
them completely off sheets. A 
washable flannel liner protects the 
ankle. Soft polyurethane foam ring 
with slick plastic shell allows pa- 
tient to move his foot freely. 
#6530 (4 inch width), 


The Posey Foot-Guard with new 
"T" bar stabilizer simultaneoUSlY 
keeps weight of bedding off foot, 
helps prevent foot drop and foot 
rotation. #6412, 


Prophylaxis of iron and folic acid 
deficiencies and treatment of 
megaloblastic anemia, during pregnancy, 
puerperium and lactation. 
Contra Indications 
Hemochromatosis, hemosiderosis and 
hemolytic anemia. 
Keep out of reach of children. 
Adverse Reactions 
The following adverse reactions have 
been reported: 
Nausea, diarrhea, constipation, vomiting, 
dizziness, abdominal pain, skin rash and 
The use of folic acid in the treatment of 
pernicious (Addisonian) anemia. in which 
Vitamin 8t2 is deficient, may return the 
peripheral blood picture to normal while 
neurological manifestations remain 
Oral iron preparations may aggravate 
existing peptic ulcer, regional enteritis 
and ulcerative colitis. 
Iron, when given with tetracyclines, binds 
in equimolecular ration thus lowering the 
absorption of tetracyclines. 
Prophylaxis: One tablet daily throughout 
pregnancy, puerperium and 
lactation. To be swallowed whole at 
any time of the day regardless of 
meal times. 
Treatment of megaloblastic anemia: 
During pregnancy. puerperium and 
lactation; and in multiple pregnancy. 
two tablets, in a single dose, should 
be taken daily. 
SLOW-Fe folic tablets have an off-white 
colour and are supplied in push-through 
foil packs of 30; available in units of 30 
and 120 tablets. 
1. Nutrition Canada National Survey A report 
by Nutrition Canada to the Department of 
National Health and Welfare. Ottawa, 
Information Canada. 1973. Reproduced by 
permission of Information Canada. 
2. R. R. Streiff, MD, Folate Deficiency and Oral 
Contraceptives, Jama, Oct. 5. 1970, 
Vol. 214. No.1. 

/ :r 
,. ' 

. ict "- 

l -- 



e . Posey Elbow Protector helps 
ellmrnate pressure sores and fric- 
tion burns. Three models are avail- 
able. #6220 (synthetic fur wlout 
plastic lining), 


The Posey Ventilated Heel Pro- 
tector helps prevent friction and 
skin breakdown while allowing 
free movement. The newl y devel- 
 closure holds hee l protector 
on t e most restless patient. #6110 
(wlplastic shell), 

Send for the free new POSEY catalog - supersedes a/l previous editions. 
Please insist on Posey Quality - specify the Posey Brand name. 

Send your order today! 
Enns and Gilmore 
2276 Dixie Road 
Mississauga, Ontario, 
Canada L.JY lZ5 
141(,) 274-2.'>7.'> 

C I B A 
See advertISement on cover 4 



I.J 1)1-111-9 lT1)(II\te 

33. Science Council of Canada 
Jopu/ation, technology and 
lesources. Ottawa, Minister of Supply 
lind Services Canada, c1976. 91p. 
'It"s Report no. 25). 
34. Statistics Canada. Canadian 
jlospita/s and related facilities, 1976. 
')ttawa, t976. 75p. 
35.-. Causes of death; provinces by 
'ex, and Canada by sex and age 
974. Ottawa. 1976. 165p. 

6.-. Hospital indicators, 
'anuary-March, 1976. Ottawa. 1976. 
37.-. Hospital morbidity 1973. 
)ttawa, 1976. 159p. 
i8.-. HospItal morbidity; Canadian 
iiagnostic list 1973. Ottawa, 1976. 
39.-. Hospital statistics 1973. 
)ttawa, 1976. 3v. 
10. Statistics Canada. Hospital 
tatistics 1974; preliminary annual 
eport. Ottawa, 1975. 44p. 
11.-. Mental health statistics, 1973. 
)ttawa, 1976. v.1 and v.3. 
'J2.-. Nursing in Canada: Canadian 
"ursmg statistics, 1975. Ottawa, 
Information Canada, 1976. 1v. 
113.-. Tuberculosis statistics, v.2 
1stitutional facilities, services and 
inances 1973. Ottawa, 1975. 24p. 
IJ4.-. Vital statistics; preliminary 
"nnual report 1974. Ottawa, 1976. 
15.-. Vital statistics, v.1 births, 1974. 
)ttawa, 1976. 47p. 
J6. Statistique Canada. Causes de 
fecés; par province selon Ie sexe et Ie 
;anada selon Ie sexe et /'age, 1974. 
)ttawa, 1976. 165p. 
J7.-. Hopitaux et établissements 
'annexes 1976. Ottawa, 1976. 75p. 
J8.-. Indicateurs des höpítaux, 
3/lvier-mars 1976. Ottawa, 1976. 
19.-. La morbiditè hospltaliére 1973. 
:>ttawa. 1976. 159p. 
,'00.-. La morbidite hospitaliére; liste 
'anadienne de diagnostics 1973. 
,)ttawa, 1976. 81p. 
101.-. Soins infirmiers au Canada' 
;tatistique des soins infirmiers 1975 
,)ttawa, Information Canada, 1976. 
102.-. La statistique de la 
ubercu/ose, v.2 - installations, 
;ervices et finances des 
tablissements 1973. Ottawa, 1975. 
1103.-. La statistique de /'état civil; 
apport annuel préliminaire 1974. 
)ttawa, 1976. 69p. 
104.-.Lastatìstiquede/'étatcivil, v.1 
- naissances 1974. Ottawa, 1976. 

105.-. La statistique de /'hygiéne 
'7Ientale 1973. Ottawa, 1976. v.1 et 
106.-. La statistique des höpitaux 
apport annuel préliminaire, 1974. 
Ottawa, 1975. 44p. 

107.-. La statistique hospitallere, 
1973. Ottawa, 1976. 3v. 

United States 
108. Center for Disease Control. 
Venereal Disease Branch. Current 
literature on venereal disease, 1976 
no. 1, Atlanta, Ga., 1976. 87p. 
109. National Centre for Health 
Statistics. Health manpower, a county 
and metropolitan area data book, 
1972-75. Rockville, Md., 1976. 74p. 
(DHEW Publication no. (HRA) 
110. National Institutes of Health. 
Medicine in Chinese cultures: 
comparative studIes of health care in 
Chinese and other societies: papers 
and discussions from a conference 
held in Seattle, Washington, U.S. 
February 1974. Bethesda. Md., for 
sale by the Supt. of Docs., U.S. Gov't. 
Print. Off., Washington, D.C., c1975. 
803p. (DHEW Publication no. (NlH) 
111.-. Statistical reference book of 
international activities, fiscal year 
1975. Prepared by International 
Cooperation and Geographic Studies 
Branch, Fogarty International Center, 
Bethesda, Md., 1976. 40p. (DHEW 
Publication no. (NIH) 76-64) 
112. National Institute on Alcohol 
Abuse and Alcoholism. Alcohol and 
alcoholism; problems, programs. 
Rockville, Md. For sale by the Supt. of 
Docs., U.S. Gov't. Print. Off., 
Washington, 1972. 42p. (DHEW 
publication no. (HSM) 72-9127) 

Studies deposited In CNA 
Repository Collection 
113. Charpentier-Poupart, Thérèse. 
Effets d'un enseignement structuré 
dispensé à des clients atteints de 
ma/adie vasculaire periphérique. 
MontréaJ, 1976. 267p. (Thèse (M.N.) - 
Montréal) R 
114. Dussault, Rita. Rapport final du 
voyage d'ètude, par... et Laurette 
Morin. QuéCJec, 1975. 59p. R 
115. Eifert, Helen. Selected aspects 
of the childbearing experience as 
described by sixty couples, by... and 
Linda Leonard. Vancouver, School of 
Nursing, University of British 
Columb4a, 1976. 31p. R 
116. Pa ri<er, Nora I. Survey of 
graduates of the University of Toronto 
baccalaureate course in nursing no. 
4, 1972, by... and Judith A. 
Humphreys. Toronto, University of 
Toronto, Faculty of Nursing. 1975. 1 v. 
(various pagings) R 
117.-. Survey of graduates of the 
University of Toronto baccalaureate 
course in nursing no. 3, 1970 and 
1971, by... and Judith A. Humphreys. 
Toronto, University of Toronto, 
Faculty of Nursing, 1973. 30p. R ... 



Open to both 
men and women 




('. .c-



Health and Welfare Canada 
Medical Services Branch, Alberta Region 
Fort Chipewyan. Alberta 

Fort Chipewyan Nursing Station 

Salary: $13,952 - $16,601 
Ref. No: 76-E.1792 (PHI 
The candidate organizes, implements and manages a com- 
prehensive public health programme for the community; 
develops and evaluates nursing personnel; assesses commu- 
nity health needs and interprets and co-ordinates Health 
Centre programmes. In Fort Chipewyan, the candidate pro- 
vides in-patient treatment service to the community. 
Eligibility for registration as a nurse in a province of Canada 
and a certificate in Public Health Nursing or a Bacculaureate 
degree in nursing are essential. Candidates must possess 
experience in the administré'tion of a Health Centr:!. Kn:>w- 
ledge of English is essential. 

(NU-CHN-3) Fort Chipewyan, Alberta 

Salary: $13,298 - $15,783 
Ref. No: 76.E-1792 (PHI 

The candidate provides treatment and public health care 
service to the community and conducts first éOid, health 
education and Immun;zation-<:ontrol clinics. 

Eligibility for registration as a registred nurse in Canada anri 
a certificate in Public Health Nursing or a Bachelor of 
Science in Nursing are required. Experience as a Public 
Health Nurse is necessary, Knowledge of English is 

How to Apply 
Forward compleleduApplicatlOn for Employment"' (Form 
PSC 367-4110) available at Post Offices. Canada Manpower 
Centres or offices of the Public Service Commission of 
Canilda, to: . 
Public Service Commission of Canada 
300 Confederation Bldg. 
10355 Jasper Avenue 
Edmonton, Alberta TSJ 1 Y6 

Closing Date: March 4,1977 
Please quote the applicable reference number at allt,mes 

('1.1HHi 11___(1 
... \(I'-(>>J-C iHe IllelltH 


British Columbia 

Employment Opportunity - Athabasea Health Unit No. 18 requires 
a Senior Public Health Nurse lor the Athabasca Office. B.Sc. qualifi- 
cation preferred and expenence essential Salary range vanes accor- 
ding to qualification and experience Apply Immediately to V. 
Markowski, Admlnlstratlve/Seety. Box 1140. Athabasca, Alberta, 
TOG OBO Phone 1-403-675-2231. 

Head Nurse - Psychiatric Unit - Position requires a R.N. with 
;>>sychiatnc training and experience In Ward Management. The unt IS 
16 beds with 6 day care units. It IS a new unit opemng In January or 
Februaryof 1977. The posillon becomes available November 1. 1976 
Salary according to RNABC contract Apply In writing to The Director 
01 Nursing. Mills Memonal Hospital. 2711 Telrault Streel. Terrace 
Bntlsh Columbia, V8G 2W7. 

British Columbia 

Operating Nurse required for an 87-bed acute care hospltalm Nor- 
thern B.C Residence accommodations available. RNASC pJlicles In 
effect. Apply to Director of Nursing, Mills Memonal Hospital, Terrace. 
British COlumbia, V8G 2W7. 

Administrator/Head Nurse - R.N wanted for Treatment/Diagnos- 
tic Centre In Pemberton, 100 miles from Vancouver, B.C. Centre IS 
under construction and successful apphcant would be required to 
work with the Board In preparation for opemng of centre Thereafter to 
be responsible to the Board for the efficient management of the 
centre. She should have broad expenence In Outpatient, emergency 
and operating room work Expenence In administration at the depar- 
tment head level would be an asset. Salary: Commensurate Wlth 
RNABC Policies. Apply Secretary, Pemberton & District Hospital 
Society, Box 312, Pemberton, British Columbia, VON 2LO 

Registered Nurses with psychlatnc training or expenence, for new 
psychlatnc unit opening January or February 1977. Salary accordmg 
to RNABCcontract. Please apply In wntlng to: The Director of Nursing, 
Mills Memonal Hospital, 2711 Tetrault Street, Terrace, British Colum- 
boa, V8G 2W7 


Â':; · 
1Ir. · I i 

" ,he h'Qt'"'' P- 
 within a radius of 100 miles of Montreal. 20 
miles of trails and slopes, 6 modem hfts, ski 
school, ski shOp and full lange of faclhlles, 
great snow and supenor grooming! 

-....... . 

Mrs. Lamb 
P.O. Box 418 
Sutton, Quebec 

1200 accommodations 
within 12 miles 

Package deals including meals, 
ski lessons and lift tickets. Let us 
know the kind of accommodation 
you wish and rest assured of our 
full cooperation for a pleasant 

British Columbia 

Faculty - New positions (4) in 2-year poSt-baslC baccalaureate I 
program In Vlctona, B.C., Canada. Generalist In focus, climcal em- I 
phasls on gerontology In community and supportive extended care I 
Units. Public Health nursing and Independent study provide opportu- 
nity to work closely with hlghly-quallfled and motivated R.N. students. 
Teaching creativity and research are strongly endorsed Master"s I 
degree, teaching and recent clinical experience In gerontology/med.- 
surg.lpsychology/rehabllitation preferred. Salaries and fringe bene- 
fits competitive; an equal oppJrtunity employer for qualified persons. 
Positions available NOW. Contact: Dr. Isabel MacRae, Director, 
School of Nursing, University of Vlctona, Victona. British Columbia, 
V8W 2Y2. 

General Duty Nurses for modern 41-bed hospital located on the 
Alaska Highway_ Salary and personnel pJliaes If! accordance With 
RNABC Accommodation available In residence. Apply Director 01 
Nursing, Fort Nelson General Hospital, P.O. Box 60, Fort Nelson, 
Brlfish Columbia, VOC 1 RO. 

General Duty Registered Nurses required by a loo-bed Acute Care 
and 40-bed Extended Care accredited hospotal Must be allglble for 
B.C. Registration. Expenence preferred. Salary $112210 $1326 psr 
month, (1976 rates). Apply In writing to the: Director of Nursing, G. R. 
Baker Memonal Hosplfal, 543 Front Street, Quesnel, Bntish CoIum. 
bla. V2J 2K7. 


Application IS inVited for a sessional faculty position In a cur- 
riculum development and evaluation project tor which funding IS 
being sought. Expertise in cinlCal teaching and curnculum develop- 
ment and evaluation required. Areas of involvement are restorative. 
ameliorative, conservative, preventive and promotive nursing. Project 
Involves a two year commitment. Salary negotiable. Apply to: Helen P 
Glass, Ed. D. Prolessor and Director, School of Nursing, University of 
Manitoba, Winnipeg, Manitoba, R3T 2N2. 

University 01 Manlfoba - School 01 Nursing - Co-ordlnato. 01 . 
Curriculum Evaluation Project - Nurse with graduate preparation 
and experience in research, curriculum and teaching, partlculany 
skilled in evaluation, and with admlmstrative abilities to co-ordinate a 
major cUrriculum development and evaluation prOject In a University 
School of Nursing. Funding is presenlly being sought for the project 
which IS expected to begin In September 1977 and Involves a 
commitment of five years. For further Information wnte to: !-ielen P. 
Glass, Ed.D., Professor and Director, School of Nursing, University of 
Maniloba, Winnipeg, Manitoba, R3T 2N2. 

University 01 Manitoba - School 01 Nursing - Applications are , 
invited for positions on the Faculty 0' a newly Initiated. progressIve, 
integrated, health oriented undergraduate nursing program. Subject 
to budgetary constraints. pJsitions are open for commumty healtt 
nursing and mental health and psychiatric nursing_ Expertise in pri- 
mary health care skills, includng health assessment of children, as 
well as rehabilitative nursing skills, beginning in Fall, 1977. Salary and 
rank negotiable. Apply to: Helen P. Glass, Ed.D., Prolessor and 
Director, School of Nursing, University of Manitoba, Winnipeg, Manl- I 
tDba, R3T 2N2. 


Director, Public Health Nursing - Applications are invited lor the 
position of Director, Public Health Nursing in this Health Unlf serving 
110,000 population. Qualifications: a Master's Degree IS preferred, 
consideration given to a Bachelor's Degree_ Applicants must have 
expenence in administration and supervision. Apply in writing to: Dr. 
Lucy M. C. Duncan, Medical Officer of Health, The Lambton Health 
Unit, 333 George Street, Samla. Ontano. NTT 4P5. I 


QualJlled Nurse Teacher - Prince Henry's Hospolal, SI. KJlda Rd., 
Melbourne, Victona, Australia - Requres a qualified Nurse Teacher 
to commence as soon as possible in our schorn. which has approxtma. I 
tely 360 students. Salary and conditions of service in accordance with 
the Determination of the ReQistered Nurses' Board. For lurther details 
please contact the: Director 01 Nursmg Services, Miss D.J. Taylor at 
the above addrass. 


eglstered Nurse required for co-ed chikiren's summer camp In the 
aurentlans (seventy miles north 01 Monlreal) from late June until late 
ugust 1977. Call (514) 4B7-5177 or wr
e. Camp MaroMac, 5901 
leet Road, Hampstead, Monlreal, Quebec, H3X IG9. 

I egistered Nurses - lor chIldren's co-ed summer camp. End 01 
Jne to end of August. Prefer season. will consider one month. 
750.00 plus travel. Wrrte: Herb Flnkelberg, Director, JewIsh 
ommunity Camps, 5151 Cote Sl. Catherine Road, Montreal, Que- 
ec, H3W 1 M6 

Jnited States 

I orne SOulh! Sunshine, warmlh & beaches - mild winters. We 
!present hundreds of clients that are seeking Canadian nurses to )010 
181r slaff. Third nation entrants need not apply These situations are 
ined, and Income levels are excellent, up to $14,000 (U.S.) lor 
"U/CCU supervisors: $13,500 lor shift supervisors and $12,000 lor 
I neral duty staff nurses. Some Situations may require State IIcen- 
.Are exam, however, most are available without examination. One 
I ""ar commitment, round-tnp Air Fare, housing assistance and Visa 
-I application assIstance is provided. Our lee is paid also - you 
ave no obligation whatsoever. For complete details, send your re- 
Jme wIth photograph and lull particulars, to: Medical Search, 3274 
uckeye Road, Atlanta. GeorgIa 30341. 

'Ieglstered Nurses - Hurtey Medical Center IS a well eqUipped, 
'Iodern, 600-bed teaching hospItal offering complete and specialized 
I ervices for the restoration and preservation of the community's 
:'ealth. It also offers onentation, in-service and contlnumg education 
)r employees II IS Involved In a bUIlding program to provIde better 
I urroundlngs for patients and employees. We have Immediate ope- 
Ings for registered nurses an such specialty Units as Cardia-Vascular, 
I )peratln g Rooms, Nurseries, and General Medocal-Surglcal areas. 
, iurley Medical Center has excellent salary and tnnge benefIts. Be- 
I orne a part of our progressive and wen qualified work force Today. 
\i>ply: NursIng Department. Mr. Garry Viele, AssocIate Director 01 
Ilurslng, Hurley Medocal Center, Flint. MichIgan 4B502. Telephone 
'313) 766-0386. 
',Iurses - ANs -Immediate Openings in Florida & Arkansas-II 
! uU are Experienced or a recent Graduate Nurse we can offer you 
oos.tJons v.ith excellent salaries 01 up to $1160 per month plus all 
I lenefits. Not only are there no fees to you whatsoever for placing you, 
Jut we also provide complete Visa and Licensure assistance at also 
,cost to you. Wrtte Immediately for our application even If there are 
I.ther areas olthe U.S. that you are Interested in. We will call you upon 
, 8elpt 0' your application In order to arrange for hospltalmterviews. 
l.indsor Employment Agency Inc., P.O. Box 1133, Great Neck, New 
I'ork 11023. (516-4B7-2BIB). 

rther your nursmg career by gaining expenence at the largest 
lchmg and acute care relerral center In Texas. This medical 
I omplex consists 017 hospItals and 1200 beds, and offers you a broad 
holce 01 nursIng speaalty and sub-specially areas In which to work. 
'ou'lIlive on semi-tropical Galveston Island (50 miles lrom Houston), 
',ith 32 miles 01 sandy beaches bordering the Gull 01 Mexico. Enjoy 
.0derate temperatures aU year long and a low cost of living. Contact: 
I,ary Clark, Asst Director, Depl. 01 Nursing, The University 01 Texas 
edical Branch, Galveston, Texas 77550. An equal opportUnity F 1M 
,\lfIrmatlve Action Employer. 

Red Deer College 

invites applications for faculty 
positions in the Diploma Nursing 

Preference given to applicants with 
advanced preparation and clinical 
specialization. who have proven 
ability in the teaching of Nursing. 

PositIons available August 1, 1977. 

Please forward application, 
comprehensive curriculum vitae and 
references to: 

Dr. Gerald O. Kelly 
Academic Dean 
Red Deer College 
Box 5005 
Red Deer, Alberta, Canada 
T 4N 5H5 

Executive Director 

Applications are invited for the position of 
Assodate Executive Director, Canadian 
Nurses Association. Ottawa. 

Candidates must be members of the 
Canadian Nurses Assodatlon, have a 
master's degree or equivalent, have at 
least five years' administrative 
experience, and be bilingual. 

Interested applicants are asked to submit 
their curriculum vitae, in confidence. to: 

Executive Director 
Canadian Nurses Association 
50 The Driveway 
Ottawa, Ontario 
K2P 1 E:;I 

We'll give you 17 hospitals 
 from... and 
throw in Miami, Palm 8each 
and Ft. lauderdale. 

RN'S.. Here's an opportunity to 
have a choice. A choice of hospitals, 
a choice of areas, a choice of special- 
ties. We offer this choice to exper- 
Ienced RN'S, new graduates all the 
way to directors level. ICU, CCU. 
Intermediate Care, 08 Peds. OR Re- 
covery, Med / Surg and Inservice. 
We provide a full service; transpor- 
tation to and from airport. hotel 
reservations, arrange and drive you 
to all appointments, housing assis- 
tance and a wealth of relocation tIpS 
For information and application, 
wnte or call Nurse RecrUiter. 
Medical Placements 
of America, Inc. 
BOO NW 62nd Street 
Ft. Lauderdale. Fla. 33309 
An Equal Opportunity Employer M/F 


with us 
, "c ..

, ; , #- 
.. 1J 
f:' . 
:. .- 

- ..--- 
, 4I!f' 
r." 1 
"i I 
\ \ 0\ 

'I"r ... 
 \ .'
. i' 

University of Kentucky 
Medical Center - 

a progressive tertiary care center 
oriented toward service. teaching 
and research. 

We offer-travel and moving 
allowance-salary commensurate 
with experience and 
education-three weeks paid 
orientation-three weeks 
vacation-10 holidays-sick leave 
benefits-paid tuition 
benefits-inservice and continuing 
education-professional freedom 
and growth. 

Write to; I 
Mrs. Dorothea Krieger I 
Assistant to the Director for Staffing I 
Department of Nursing I 
University of Kentucky I 
Lexington, Kentucky 40506 I 

Name ____ _____ 
Address __ 
City ____ ____ ____ 
State ________ Zip _____ 
Degree __________ 
Date of Graduation ______ 


An Equal Opportunity Employer 






Faculty members will be required for 
positions In expanding four-year basic 
and two-year post-R.N. baccalaureate 
programs Applicants should have 
graduate education and experience in a 
clinical area and/or in curriculum 
development or research. 
Short-term or visiting appointments may 
also be available in some areas to replace 
staff on leave. 
Salary and rank commensurate with 
qualifications and experience, in accord 
with University policies. 
Positions are open to male and female 
Please make further inquiries, or 
submit application and curriculum 
vitae to: 
Amy E. Zelmer, Ph. D. 
Faculty of Nursing 
The University of Alberta 
Edmonton, Alberta 
T6G 2G3 

I ne Lanaalan Nurse 

Okanagan College 
Okanagan College is establishing 
the second year of a new Diploma 
Nursing Program. Applications are 
invited for instructional positions. 
Four appointments will be made in 
the Spring of 1977; a fifth 
appointment will be made at the end 
of the year. 
Classroom and clinical instruction; 
curriculum development; other 
duties as assigned by the 
Coordinator of Nursing Education. 
Instructors will be required to travel 
to nearby communities. 
Master's Degree preferred; 
Bachelor's minimum. Teaching 
experienæ desirable; at least two 
years' clinical experience essential. 
Salary and working conditions in 
accordance with the Academic 
Faculty Agreement. 
Applications and information: 
The Principal 
Okanagan College 
1000 KLO Road 
Kelowna, B.C. V1 Y 4X8 
Closing date: March 15, 1977. 

Applications are invited from suitably qualified 
candidates for the post of Nurse Tutor in the University 
of Nigeria Teaching Hospital, Enugu. 

Qualifications and Experience 
Candidates should be Registered Nurse Tutors. 
Previous teaching experience is an advantage. The 
appointee will teach general nursing subjects for new 
standard of nurse training. 

(Grade Level 08, N3,264 - N4, 164) 

Conditions of Service 
Conditions of service are similar to those in the Federal 
Public Service - passages for appointee and family 
fringe benefits including pensions scheme, leave car 
allowance, part-furnished accommodation or rent 
supplement at the approved rate in lieu, and free 
Medical services. 

Method of Application 
Full curnculum vitae and names and addresses of 3 
referees to: 
Ag. Director of Administration 
University of Nigeria Teaching Hospital 
P.M.B. 1129 
Enugu, Anambra State, Nigeria 
Closing Date: March 1977. 

t'eDruary 1 
 I f 

The Montreal 
Children's Hospital 

Registered Nurses 
Nursing Assistants 

Our patient population consists of the 
baby of less Ihan an hour old 10 Ihe 
adolescenl who has just turned 
seventeen We see them in Intensive 
Care, in one of the Medical or Surgical 
General Wards. or in some of the 
Pediatric Specialty areas. 

They abound in our clinics and their 
numbers increase daily in our 

If you do not like working with children and 
wilh their families, you would not like it 

If you do like children and their families, 
we would like you on our staff. 

Interested qualified applicants should 
apply to the: 

Director of Nursing 
Montreal Children's Hospital 
2300 Tupper Street 
Montreal. Quebec, H3H 1P3. 

Director of Nursing 
Dryden District General Hospital 

Dryden District General Hospital is a 75 bed accredited 
hospital located in the Town of Dryden, population 7,000, area 
served 15,000. Dryden is midway between Winnipeg and 
Thunder Bay on the Trans-Canada highway in the midst of the 
Patricia Tourist Region. Transair provides twice daily jetflights 
to Toronto and Winnipeg. 

Many cultural and recreational opportunities are available to 
residents of and visitors to the community. 

Experienced applicants with a university degree will be given 
preferenæ but experienæ in a supervisory capacity in a larger 
hospital will reæive consideration. Employees benefits are 
generous, salary is negotiable. Employment is available 

Please write or telephone to: 
Dryden District General Hospital 
Dryden, Ontario Phone: 807-223-5261 



Prince George, British Columbia 


A number of positions will be available beginning in 1977 for 
qualified faculty to participate in a new Diploma Nursing 
Program scheduled to commence September, 1977. 

Preferred Qualifications: 

A Baccalaureate degree and registration. or eligibility for 
registration, with the Registered Nurses Association of B.C. 

A minimum of two years nursing practice or relevant 
teaching experience. 

Applications presently on file will be considered. 

We offer excellent salaries and a complete fringe benefit 

To apply: Sumbit a complete resume together with the names of 
three references to: 
Dr. F.J. Speckeen, Principal 
The College of New Caledonia 
2001 Central Street 
Prince George, B.C. V2N 1 P8 

Extension Course in Nursing Unit 

Applications are invited for the extension course In Nursing Unit 
Administration, a program to help the head nurse, supervisor or 
director of nursing up-date his or her management skills Candidates 
will be registered nurses or legistered psychiatric nurses employed in 
management positions on a full-time basis. 

The program provides a seven month period of home study with two 
five day intramural sessions, one preceding and one following the 
home study. For the 1977-78 dass the initial intramural sessions will 
be held regionally as follows: 

Vancouver August 22 -26 
St. John's (Nfld.) August 29 - September 2 
Winnipeg August 29 - September 2 
Montreal (French) August 29 - Seplember 2 
Hamilton September 12 -16 
Ottawa Seplember 12 -16 
Toronto September 19 -23 

Early application is advised. Applications will be accepted until May 
16. 1977, if places are still available atthattime. After acceptance. the 
tuition fee of $275.00 is payable on or before July 1. 1977. 

The program is co-c::nonsored by the Canadian Nurses Association 
and the Canadian Hospital Association and is available In French orin 

For additional information and application forms write to: 
English Program: 
Extension Course in Nursing Unit Administration 
25 Imperial Street 
Toronto, Ontario 
M5P 1 C1 


C'.'l , 





Open 10 bolh 
men and women 

Health and Welfare Canada 


Join the team providing health care to the residents 
of the Northwest Territories. 
Medical Services, Northwest Territories Region 
will be offering a number of term positions for qua- 
lified and experienced nurses. 
Positions are available at nursing stations, 
health centres and hospitals for the period, May 
through September. 
Knowledge of the English language is essential. 


NOTE: Permanent positions are also available 

For more information, clip and mail the coupon 
below to: 

Personnel Administrator 
Medical Services 
Northwest Territories Region 
Health and Welfare Canada 
14th Floor, Baker Centre 
10025 - 106th Street 
Edmonton, Alberta T5J 1H2 
or call collect: (403) 425-6787 
. Name · 
I Address I 
I City I 
L Postal Code .J 







Experienced nurses are needed to 
work in AFRICA, ASIA and LATIN 
AMERICA. Background in 
community health nursing Or 
teaching is an asset. 

Two year contract; local, not 
Canadian salary, transportation 
costs paid by CUSO. 
For more information, please 

CUSO Health - 12 
151 Slater Street 
Ottawa, Ontario 
K1 P 5H5 

Clinical Specialist 

We require the services of an articulate, 
dynamic nurse with a Master's Degree 
and a Major in Medical-Surgical nursing. 
We are a 300 bed Hospital Complex on 
the verge of a major expansion. We are 
close to fine recreational and cultural 
The nurse in this position will work closely 
with our Medical Staff, Administrative 
Staff and Staff Nurses to further develop 
patient centered projects. The salary and 
benefits are based on the qualifications 
and experience of the applicant. 
For further information about this 
opportunity, please forward a 
complete resume to: 
Director of Personnel 
Red Deer General Hospital 
Red Deer, Alberta 
T 4N 4E7 

Port Saunders Hospital 
requires one Registered 
Nurse commencing May 
1977 through to October 

Applicants must be registered Or 
eligible for registratic.n with the 
Association of Registered Nurses of 
Salary is on the scale of $9,963 to 
Living-in accommodations available 
for single applicants. 

Applications should be addressed to: 
Mrs. Madge Pike 
Director of Nursing 
Port Saunders Hospital 
Port Saunders, Newfoundland 

The CanadIan Nurse 

Dr. Helmcken Memorial 
Clearwater, B. C. 
Director of Nursing for a 20-bed 
general hospital located 70 miles 
north of Kamloops. B. C. 
To be responsible for all aspects of 
nursing care and the day to day 
operation of the hospital. reporting to 
area administration at Royal Inland 
Hospital. Kamloops, B. C. Must be 
eligible for B. C. registration with 
previous administrative experience 
and preferably with advanced 
Salary negotiable with generous 
fringe benefits. 
Apply to: 
Personnel Director 
Royal Inland Hospital 
Kamloops, B. C. V2C 2T1, Canada 

Offers a 13-week 
For further information and detail 
Associate Director of Nursing 
Halifax, Nova Scotia 
B3J 3G9 

Head Nurse 

The Position: 
Directing an active 40 bed surgical unit 
with opportunity for future advancement. 
The Person: 
Should have a Baccalaureate degree with 
a clinical specialty and/or administrative 
The Hospital: 
Central Alberta location in an expanding 
regional hospital. 
The City: 
30,000 population half way between 
Edmonton and Calgary and close to the 
best in skiing and recreation centres. 

Please send complete resume to: 
Director of Personnel 
Red Deer General Hospital 
Red Deer, Alberta 
T4N 4E7 

February 1977 

University Faculty 

Applications are invited for the position of 
Assistant or Associate Professor of 
Community Health Nursing in a basic 
University program enrolling 
approximately 200 students. 
A Master's degree and expertise in 
practice are required. Preference given to 
candidates with graduate preparation 
and/or experience in Maternal Child 
Nursing. Teaching experience in a 
university program is desirable. 
Candidate must be eligible for registration 
in Ontario. 
Salary commensurate with qualifications. 
Apply in writing giving curriculum 
vitae to: 
Dr. E. Jean M. Hill 
Dean and Professor 
School of Nursing 
Queen's University 
Kingston, Ontario K7L 3N6 

Head Nurse 

with preparation and/or 
demonstrative competence in 
Psychiatric Nursing and 
Management functions. required for 
Head Nurse appointment. To be 
responsible for participation in the 
organization. initiation, and the 
management of a New Psychiatric 
In-patient Unit. 

Please apply, forwarding 
complete resume to: 
Director of Personnel 
Stratford General Hospital 
Stratford, Ontario 
NSA 2Y6. 

General Hospital 
St. John's 


Staff Nurses are required for a 354 
bed hospital with adult medicine, 
surgery, orthopaedics. 
neurosurgery. neurology, 
cardiovascular and urology services. 
Liberal fringe benefits and salary 
according to the Collective 
Starting salary $10,800 (new 
Contract being negotiated shortly). 
Applications should be forwarded to: 
Personnel Director 
General Hospital 
Forest Road 
SI. John's, Newfoundland 
A1A 1E5 


IJ \, 


Ste. Anne de Bellevue 
(Suburban Montreal) 


Requires additional teaching staff 
for September, 1977. 
Applicants should possess an R.N. or eligibility for licensure in 
Quebec. a Bachelor's degree in Nursing and a minimum of two years 
general nursing experience. 

John Abbott College is a community college serving the West Island 
community of Montreal. It offers a parl<-like setting close to the aty, 
on-campus sports, recreation, and the possibility of residence close to 
the campus. 

Teaching salaries according to Quebec Teachers' Scales, excellent 
fringe benefits. group insurance, pension plan, health benefits. and 2 
months paid vacation. 

Address application and completed curriculum vitae to the: 
Director of Personnel 
P.O. Box 2000 
Ste. Anne de Bellevue, Quebec H9X 3L9 


invites applications for the position of 


This position entails managing the affairs of the 
7200-member association. Duties include participating 
in the development and implementation of policy, 
budgeting and financial management, communication 
with groups and individuals. The successful applicant 
will have over-all responsibility for a staff of 12, and will 
answer directly to the association's governing council. 
Salary: Negotiable. 
Qualifications: Applicants must have a 
master's/baccalaureate degree with a major in 
administration, several years' experience in an 
administrative position or related experience, and be 
eligible for registration with the Saskatchewan 
Registered Nurses' Association. 

Applications, giving full details of education, 
qualifications and experience, should be sent to: 
Mrs. Sheila Belton 
Chairman, Selections Committee 
59 Empress Drive 
REGINA, Saskatchewan 
S4T 8M7 


...1. l' 

@. .1:'; 


.. . 


.'-- Canada's 
Health Service 

Medical Services Branch 
of rhe Department of 
National Healrh and Welfare employs some 900 
nurses and rhe demand grows every day. 
Take the North for example. Community Health 
Nursing is the major role of rhe nurse in bringing health 
services to Canada's Indian and Eskimo peoples. If you 
have rhe qualifications and can carry more than the 
nonnalload of responsibility... \\hy not find out more? 
Hospital Nurses are needed too in some areas and 
again rhe North has a continuing demand. 
Then there is Occupational Health Nursing which in- 
cludes counselling and some treatment to federal public 
You could work in one or all of these areas in the 
course of your career, and it is possible te advance to 
senior positions. In addition, rhere are educational 
opportunities such as in-service training and some 
financial support for educational leave. 
For further infonnation on any. or all, of these career 
opportunities, please contact rhe Medical Services 
office nearest you or write to: 

Medical Services Branch I 
Department of National Health and Welfare 
Ottawa, Ontario K1A OL3 

I Name 
I Address 
I City 
I . * Health and Welfare Sante et Bien-etre social 
Canada Canada 



Assistant Director 
Nursing Services 

McMaster University Medical Centre is seeking an 
Assistant Director of Nursing Services. 

An excellent career opportunity exists for a qualified 
innovative individual to fill a demanding position 
involving responsibility for specific 
in-patient/out-patient areas. The incumbent will have 
the opportu nity to plan, establish, implement, and di rect 
nursing care. 
Interested candidates are required to have the 
managerial ability to work with .11 levels of nursing, 
administration and medical staff. 

Must be currently registered in the Province of Ontario. 
Preference will be given to candidates with additional 
educational preparation and experience in nursing 
Resumes should be sent to: 
Mr. R. E. Capstick 
Manager, Employment & Staff Relations 
McMaster University Medical Centre 
1200 Main Street West 
HAMILTON, Ontario 
LaS 4J9 

Dalhousie University 
School of Nursing 


Dalhousie University School of Nursing invites 
applications for faculty positions in a rapidly expanding 
graduate programme which offers clinical specialties in 
Medical-Surgical and Community Health Nursing. 

Faculty should have post-masters or doctoral 
preparation with experience in clinical nursing and 
nursing education. Rank and salary for positions 
commensurate with qualifications and experience, and 
in accord with the salary schedule of Dalhousie 

Applications and further information may be 
obtained from: 
Dr. Margaret Scott Wright 
Professor and Director 
School of Nursing 
Dalhousie University 
Halifax, Nova Scotia 
83H 4H7 

The Canadian N.... Febru.ry 1911 

Index to 
February 1977 

The Canadian Nurse's Cap Reg'd 33 
C I BA 56, Cover 4 
The Clinic Shoemakers 2 
Designer's Choice 5 
Equity Medical Supply Company 51 
Hollister Limited 22 
Frank W. Horner Limited 48 
Kendall Canada 51 
Miller-Stephenson 1 
Mont Sutton 58 
The C.v. Mosby Company Limited 7, 9, 11, 13 
Nordic Pharmaceuticals Limited 40 
Posey Company 56 I 
Procter & Gamble 49 
Reeves Company 55 
W.B. Saunders Company Canada Limited 53 
G.D. Searle 14 
Stiefel Laboratories (Canada) Limited 21 
The Uniform Shop of Peterborough Limited 27 
Uniform Specialty Cover 3 
White Sister Uniform Inc Cover 2 , 
Gerry Kavanaugh 
The Canadian Nurse 
50 The Driveway 
Ottawa, Ontario K2P 1 E2 
Advertising Representatives 
Richard P. Wilson 
219 East Lancaster Avenue 
Aldmore. Penna. 19003 
Telephone: (215) 649-1497 
Gordon Tiffin 
2 Tremont Crescent 
Don Mills, Ontario M38 281 
Telephone: (416) 444-4731 
Member of Canadian I:m!I 
Circulations Audit Board Inc. 

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Prophylactic iron and folic acid supplementation recently, a number of physicians have queried the 
during pregnancy is now an accepted practice effect of oral contraceptives on serum folate levels 
among Canadian physicians. It has also been in women. Dr. Streiff reports: "This complication 
established, through the publication in 1974 of (of oral contraceptive therapy), however, may be 
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moderate risk of low serum folate levels. More 

Dorval. Quebec 

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C.H.D. patients and others at hyperlipid risk may now look 
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This is made possible by unique Egg Beaters from 
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THE CLINIC SHOEMAKERS · Dept. CN-3 7912 Bonhomme Ave. . St. Louis. Mo. 63105 

,ho øøwødløw 

The official Journal of the Canadian 
Nurses Association published 
monthly in French and English 

March, 1977 

Volume 73, Number 3 


Input 6 
News 12 
Names 52 A Question of Balance Lynda Ford 19 
Calendar 54 Clinical Wordsearch II 4 Mary Elizabeth Bawden 25 
Books 55 The Role of the Head Nurse Vivian Good, Diane Bartels 
in Primary Nursing Susan Lampe 26 
Library Update 56 Mirroring: The leukemic Child June Kikuchi 31 
Frankly Speaking: 
Specialization in Nursing Eleanor G. Pask 34 
A Program That Dares 
to be Different Judith M. Skelton 36 
The Nurse's Role in Health 
Assessment and Promotion RNABC Position Paper 40 
Fetal Monitoring 
- Why Bother? Ellen Hodnett 44 
The Other Side of the Uniform: 
living with Adult Still's Disease Yolanda Camiletti 48 


lit +t 
) :+ 

The pins on this month's cover are 
from CNA's collection of nursing 
school pins on permanent display in 
the Archives at CNA House. The 
collection began ten years ago with 
donations from the estates of two 
former CNA members and has grown 
since then to include the 16 pins 
pictured on the cover. The Association 
is anxious to expand its collection to 
include a more representative 
selection from both existing and 
former schools of nursing. If you would 
like to see your school represented, 
please contact the librarian, CNA 
House. For identification of pins, see 
page 4. (Photo by Studio Impact). 

The views expressed in the articles 
are those of the authors and do not 
necessarily represent the policies of 
the Canadian Nurses Association. 

ISSN 0008-4581 

Indexed in International Nursing 
Index, Cumulative Index to Nursing 
Literature, Abstracts of Hospital 
Management Studies, Hospital 
lIterature Index, Hospital Abstracts, 
Index Medlcus. The Canadian Nurse 
is available In mlcrofolm from Xerox 
University Microfilms, Ann Arbor. 
Michigan. 48106. 

The Canadian Nurse welcomes 
suggestions for articles or unsolicited 
manusclipts. Authors may submit 
finished articles or a summary of the 
proposed content. Manuscripts should 
be typed double-space Send original 
and carbon. All articles must be 
submitted for the exclusive use of The 
Canadian Nurse. A bloglaphical 
statement and return address should 
accompany all manuscllpts. 

A Canadian Nurses AssocIatIon. 
1:::( 50 The Driveway, Ottawa Cj'lnada, 
K2P 1 E2. 

Subscription Rates: Canada: one 
year, $8.00; two years, $15.00. 
FOlelgn: one year, $9.00; two years, 
$17.00. Single copies. $1.00 each. 
Make cheques or money orders 
payable to the Canadian Nurses 

Change of Address: Notice should be 
given in advance Include plevlous 
address as well as new. along with 
registration number, In a provlncial/ 
territorial nurses' association where 
apphcable. Not responsible for 
journals lost in mail due to errors In 

Postage paid in cash at thIrd class rate 
Montreal, P.Q. Permit No. 10,001. 

 Canadian Nurses Association 


I)(>>I-"I)(>>(-t Ît'e 


Is nursing in Canada going through an 
identity crisis? One that affects 
130,000 practising nurses and 
thousands of young people who hope 
to follow in their steps? One that 
troubles employers as well as 
educators, and recipients, as well as 
providers of health care? 
Over the past 12 months, I have 
listened to many leaders of the nursing 
profession as they talked to their 
fellow nurses in groups across this 
country. I have come away from these 
meetings convinced that in order to 
consolidate the gains they have made 
in the first half of this century in the 
advancement of the profession, 
nurses are going to have to find some 
way of reaching a concensus on some 
very basic questions '" questions like 
what it is that they do and who it is that 
makes the decisions and accepts 
responsibility for their actions. 
Certainly, nursing does not stand 
alone in facing this threat to its identity 
.., if it is a threat. All ofthe professions, 
but particularly the health professions, 
are presently undergoing what has 
been called a "crisis of public 
confidence" that is forcing them to 
take a long, hard look at how close 
they actually come to meeting the real 
needs 01 society today. 

11(>> .-(>> Î II 

Inevitably, however, it IS criticism 
01 the nursing prolession and 
questions about nursing and nursing 
care that concern us most closely and 
What does it mean, lor example, 
when the majority 01 
nurse/respondents to a survey on 
quality 01 care in the United States and 
Canada describe the care they see 
around them as "low grade B"? 
What is our own reaction to the 
challenge of rising consumer 
expectations whén we are faced with 
budget constraints and administrative 
decrees that leave us with neither the 
time nor the energy to think 01 the 
patient as a person who depends on 
us to help him achieve his goal of 
Is it true that the nurse is 
becoming a "jack-ol-all-trades and 
master 01 none" and, il it is, what can 
we do about it? 
Are we really in danger, as one 
nurse/educator claims, 01 losing our 
essential caring quality and, in lact, 
our sense 01 the wholeness 01 
In this issue of CNJ, three nurses 
who have worked within a primary 
nursing set-up, describe the 
difference this makes to their 

M. Anne Hanna 

Assistant Editors 
Lynda Ford 
Sandra LeFort 
Production Assistant 
Mary Lou Downes 
Circulation Manager 
Beryl Darling 
Gerry Kavanaugh 
CNA Executive Director 
Helen K. Mussallem 

perception 01 their role within the J 
health care system. For them, the 
"one nurse, one patient, planning care l 
together approach" and the 
responsibility that this entails makes i 
a little easier to answer the 
lundamental question that all nurses 
are laced with now: "Who am I, what 
am J doing here, and where am I 
going?" - M.A.ti 



Key to cover photo: 
1. Hotel-Dleu du Sacre-Coeur de 
Jésus, Ouebec, P.O. 
2. Algonquin College, Ottawa, Ont. 
3. Victoria Hospital, Winnipeg, Man. 
4. Hópital Géneral d'Ottawa, Ottawa, 

,5. Royal Victoria Hospital, Montreal, 
6. Vemon Jubilee Hospital, Vernon, 
7. Memorial University, St. John's, 
8. Ottawa Civic HospItal, Ottawa,Ont. 
9. Montreal General Hospital, 
Montreal, P.O. 
10. The Moncton Hospital, Moncton, 
11. Toronto General Hospital, 
Toronto, Ont. 
12. Metropolitan General Hospital, 
Windsor, Ont. 
13. Kelsey Institute of Applied Arts 
and Sciences, Saskatoon, Sask. 
14. Metropolitan (Demonstration) 
School of Nursing. Windsor, Ont. 
15. Winnipeg General Hospital, 
Winnipeg, Man. 
16. Regina General Hospital, Regina, 

... "Thebestis yettobe, the/astoflife, 
for which the first was made. " I 
How do you feel about growing I 
older - as an individual or as a nurst 
who cares for our older people? Ne) 
month, CNJ explores the subject at II 
aging as it involves nursing and yoL! 
We'll look at what goes on in a day I 
hospital in Edmonton, Alberta. a 
nursing home in Hamilton, Ontario, I 
and a geriatric center in Toronto, 
among other places, and talk about 
some practical ways that nurses cal l 
help to make the last 01 lile a little 
better lor these important people. 


Æ'NI'u Lu'/I



No. 169 

E E W 
No. 100 ----- \LL \AM... 
OR. R(S\O(trt" 




No. 559 

R\ · 
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e êJitra <:neet for a,jdltional Items r :;rdo:>r;:. 

Name for ENGRAVING: 
NAME PI N S: Print Lettering below, check appropriate 

Lettering _ 

_ Id l 

lffiERIMG PRICES. t Pi. 




o Duotone 1 0 Black J Lme 
o Gold 0 Pohshed 0 Dk Blue lettering 0269 04.4 
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:;: -- 
Card No.. Expiration Date and your signature. _ 

Send to 






The Canadian Nurse Msrch 1977 

The Canadian Nurse invites your 
letters. All correspondence is subject 
to editing and must be signed, 
although the author's name may be 
withheld on request. 


The quality of our caring 
Thousands of cancer patients 
must now present themselves, usually 
in a teaching hospital, for review and 
treatment on a regular basis. As 
controls improve, many of us are living 
much longer than expected and must 
be considered "problems" by 
professional staff - secretaries, 
technicians, nurses, and doctors. We 
flood existing facilities at all levels and 
place a great strain on too few 
hematologists and oncologists. 
I am myself a chronic patient, 
beginning my fifth year of therapy in 
two centers - one for cobalt, one for 
chemo. I am concerned about what is 
happening to me and to others like 
myself. Somehow, in the treatment of 
some incurable diseases, when 
patients must be treated or they will 
die, "Equal Rights" has come to mean 
"Everyone is the Same." When this 
happens, individual identity is lost: the 
patient becomes a nonentity - a 
cipher- a case. 
Some questions anse: 
Why must patients endure 
several inept attempts to draw blood, 
or insert I.V.'s? 
Who decided that patients have 
hours to waste in crowded waiting 
rooms, waiting for tests or to see their 
doctors? Why are they not seen or 
treated on an appointment basis? 
Why are patients' names called 
on a P.A. system, or bellowed by a 
staff member without courtesy of a 
Why are they herded in groups, 
sometimes undressed, from one place 
to another? 
Does the patient know the name 
of the doctor responsible for his care? 
How often does he see that doctor? 
Is the patient required to submit to 
examination by a different doctor each 
time? What happens if he refuses 
such examination? 
Is the patient threatened in any 
What does a patient, being 
treated as an out-patient, do when he 
has a bad reaction, calls his doctor's 
office for advice, and is told the doctor 
does not speak to patients on the 
Who decided it is better for 
patients, admitted for therapy, to 
share rooms, bathrooms. even a 
whole floor with other cancer patients? 
Pemaps, it is better for the staff? Is a 

pallent entitled to any privacy? Who 
answers his questions if he never sees 
his doctor alone? How does the 
patient who is lying in bed feel, when a 
group standing around, discusses him 
as if he were non-existent? 
We patients know some of the 
answers to these questions and 
appreciate at least some of the 
problems that are encountered in our 
care. But, again, the question arises 
- how many of the answers are 
merely excuses? 
It does seem to me that the 
patient is caught in a rapidly 
developing atmosphere of 
indifference, intimidation, and 
coercion. Most certainly we need 
medical care for our future 
generations, but it distresses me to 
think that my children and 
grandchildren may endure the added 
anxieties and frustration that attend 
what, at its best, must be called 
difficult therapy. 
Pemaps patients might be asked 
for suggestions as to their needs or 
Pemaps the time has come for 
patients to teach attending staff, by 
expressing their thoughts regarding 
attitudes and treatment at all levels. 
Pemaps the time has come, too, 
for attending staff to be reminded that 
patients are individuals - they do 
have feelings and are entitled to 
courtesy and respect. 
- M.E Murray, Toronto, Ontario. 

Paraplegics revisited 
In the December issue of The 
Canadian Nurse the article "Towards 
Independence for Paraplegics" had 
two minor errors. On page 25, the 
brace (upper photo) is a Jewitt 
Hyperextension brace, not 
hypertension brace. 
The other is on page 27, middle of 
page, when mentioning the 
radiological examination of a dynamic 
voiding cysto-urethrogram to 
determine the cause of bladder 
dysfunction, be it due to spasm of the 
external sphincter, urethral strictures, 
bladder calculi or reflux. A reflux, if 
present, is seen during this 
examination, but is a complication of 
bladder training, rather than a direct 
cause of dysfunction, as are the other 
mentioned factors. 
- Ane Marie Hansen, R.N., Toronto, 

Brash, pretentious, abrasive? 
My response to your invitation to 
comment on the topic of M.A. 
Wickham's letter (December, 1976) 
It was with some surprise that I 
realizedthattheJune, 1974 resolution 
to omittitles such as Miss or Mrs. in all 
CNA communications would result in 
only the surname of an individual 
being used. 
This practice creates a harsh and 
abrasive tone. - 
Would it not be more appropriate 
to refer to the individual by his/her fi rst 
- Mardy Brown, Gulf Station, South 
Hazelton, B. C. 

The practice of referring to 
nursing professionals with "bare" 
surnames communicates a kind of 
brash pretentiousness. The use of 
surnames only calls forth a reaction of 
both physical (cringing) and emotional 
dimension. Why not use the person's 
first name or title appropriate to their 
status? This practice was popular in 
early nursing-training experience 
when one's best friends found the title 
"Miss" cumbersome while working in 
patient-care areas. Pemaps the use of 
the "bare surname" conjures up 
reflections of the driving work ethic 
during a period of experience (utility 
rooms, waste baskets, maps and 
dusting) which many would prefer to 
I find it unattractive in our)iterary 
- Thelma Potter, Reg. N., Toronto, 

I, too, abhor the use of bare 
surnames in The Canadian Nurse. I 
thought initially that I would gradually 
adapt to this, however, this has not yet 
happened. It seems such a paradox 
when we talk about personalizing care 
for our patients; yet, our professional 
journal addresses individuals in this 
coldly impersonal manner. 
- Bonnie Hartley, Graduate Student, 
Faculty of Nursing, University of 
Western Ontario. 

Abortion counselling 
I was very pleased to read the 
article "Abortion Counselling" by 
Bonnie Easterbrook and Beth 
Rust (January, 1977). 

Canadian hospitals have been 
avoiding their responsibility of 
providing abortion services. Statistics 
Canada lists 258 hospitals, out of 
1,359 in Canada, with Therapeutic 
Abortion Committees. A 1975 surve} 
conducted by the Doctors for Repea I 
of the Abortion Law (DRAL) shows 
that only one-third of Canadian I 
hospitals that are technically equippec I 
to perform abortions are listed as 
having such a committee. The 
overdue report of the govemment 
funded Badgley Commission which IS 
investigating the application of the 
present abortion law in Canadian 
hospitals should provide more curren 
Abortion counselling by 
competent personnel is an essential 
health service which more hospitals I ' 
should provide. Sensitive, concemec 
nurses can expand their role into this: 
important health care area. Please I 
keep us informed of current 
- Linda Ratcliffe, Reg. N., C.P., 
London, Ontario. 

Long-term care for RN's 
The December 1976 issue of ThE I 
Canadian Nurse has an 
announcement in the "News" columr 
of Canada's "first" extended care 
program for registered nurses at 
Grant MacEwan College in 
Edmonton, Alberta. 
Our program here at Centennia 
College in Scarborough, Ontario, I 
entitled "Certificate of achievement fa 
registered nurses in Long-Term Care' 
has been in operation now for almos I 
two years, and was approved by the i 
Council of Regents of our provincial I 
Ministry of Colleges and Universities 
Those of us involved with the 
formation, development and 
implementation of the program feel 
that it meets a real need, and we are 
delighted to see other colleges 
develop programs of similar nature. 
- Patricia Prentice, Coordinator of 
Applied Arts/Academic/ Health 
Programs, Continuing Education 
Division, Centennial College of 
Applied Arts and Technology, 
Scarborough, Ontario. 

In this high pressured world of caring and doing and bending and reaching, 
walking miles of aisles and wondering whether anybody out there cares...We 
do Barco backs every stitch of every look, every day. 
Barco Backs You, Bab


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Turtle Neck, 5564, about 513 In Barco Stretch 'N Knit. 
Write for your complimentary Uniform Brochure to: Barco, 350 West Rosecrans Avenue, CN-77, Gardena, California 90248. 
Barco, one of the finest names in Uniforms and Shoes is proud to be in Canada. 
Please look for Barco at the store nearest you. 
UNIRJRM WORLD, 3 Coumbe St., Renfrew, Ontario; 226 Bank St., Ottawa, Ontario; 641 Bay St., Toronto, Ontario; 691 McCowan Rd., 
Scarborough, Ontario. flORENCE NIGHTINGALE, 156 James 5t. South, Hamilton, Ontario. SALON FANTASIA, 562 St. CathErine 
East, Montreal. Quebec. ROSE-LEE UNIFORMS, 837 5herbrook, Winnipeg, Manitoba; 265 Kennedy, Wmnipeg, Manitoba. ROSE 
UNIFORMS, lOI75-100A St., Edmonton, Alberta. DORIS UNIFORMS, 618 3rd St. S.W., Calgary, Alberta. VOGUE UNIFORMS, 116 8th 
Ave., Calgary, Alberta. IMAGE UNIFORMS, 734 W. Broadway, Vancouver, B.C; 1027 Davie St., Vancouver, B.C; Cariboo Shopping 
Center, Coquitlam, B.C NEW IMAGE, 675 3rd St. S.E., Medicine Hat, Alberta. 


The Canøcllan March 1977 


Rely on Mosby. No other publisher offers you such 
opportunities for choice in eV8ty nursing specialty. 

New 2nd EditIOn 

A Client Approach to Nursing 
The new edition of this pacesetting text continues 
its unique approach by interweaving both adult and child 
care, and organizing material according to five basic human 
needs (safety and security, activity and rest, sexual role 
satisfaction, need for oxygen, nutrition and elimination) Re- 
taining the innovative features which made the first edition so 
popular, the authors have made significant revisions that 
enhance this text's effectiveness. Here's how they've 
amplified this new 2nd edition: 
. an increased emphasis on applied pathophysiology evi- 
denced throughout; 
. major expansion of material on the central and peripheral 
nervous systems Included are new chapters on neurolog- 
ical assessment, brain and spinal cord; 
. the latest information on assessment and management of 
oncologic problems. New tables summarize nursing ac- 
tion and pharmacotherapy; 
. revised and expanded chapter on the cardiovascular sys- 
tem with new material on assessment of dysrhythmias and 
new material on myocardial infarction and pump failure: 
. more information on nursing management of fluid and 
electrolyte problems; 
. the section on sexual role satisfaction contains new infor- 
mation on assessment techniques in breast cancer and 
venereal disease along with client instruction techniques. 
A new section on rape considers prevention and treat- 
. additional learning aids; more than 100 new illustrations 
plus additional assessment guides and summary tables 
By Janet Miller Barber, R.N., MS.; Lillian Gatlin 
Stokes, R.N., MS., and Diane McGovern Billings, R.N., MS. 
March, 1977. Approx. 1,024 pages, 8" x 10", 738 illustra- 
tions About $18.85. 

LEMS. By Dorothy J. Brundage, MN. A clear presentation of 
the physiologic and psychologic bases for nursing interven- 
tion, this unique text approaches nephrology as a vital sub- 
system of the whole body system. It offers in-depth informa- 
tion on normal and pathologic renal function; causes of renal 
disturbances; body responses and acute renal failure; medi- 
cal therapy; and nursing intervention. Methods and proces- 
ses of renal restoration are carefully detailed, with special 
attention to dialysis and transplantation and their psychoso- 
cial aspects. 1976, 214 pp., 20 illus. Price, $7.30. 


New 3rd Edition! NURSING CARE OF THE 
CANCER PATIENT. By Rosemary Bouchard, AB., AM, 
EdD.. R.N. and Norma F. Owens, A.B., AM, Ed.D., R.N. This 
new edition presents up-to-date discussions on prevention, 
detection, and diagnosis of cancer, and explains the effects 
of cancer on all major body systems. The authors discuss 
traditional cancer therapy - surgery, radiation, and 
chemotherapy - and explain nursing approaches to each. 
Rehabilitation and care of the terminal patient are explored 
in depth. Special consideration is given to the psychological 
aspects of primary and advanced disease along with nursing 
methods to help provide emotional support. June, 1976.325 
pp., 189 illus. Price, $9.40. 

NURSING: An Introduction. By Rose Marie Barach, R.N., 
MA., with 4 contributors. This dynamic new book ap- 
proaches the theory and practice of rehabilitation f!om .a 
psychosocial perspective. Contributions by specialists In 
community health, orthopaedic rehabilitation, and sexual 
function stress ways to meet the physical, emotional, and 
social needs of the rehabilitating patient. Informative dis- 
cussions offer new insights on the health care environment; 
physical and psychosocial functions in health related 
therapies; and application of the nursing process. Sep- 
tember, 1976. 328 pp., 60 illus. Price, $8.95. 

-' ,

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ed by Diana W Guthrie R.N., 
MS.P.H.. F.AAN and RIchard A Guth"e, MD., F.AAP.; 
with 9 cont"butors. This important new text presents up-to- 
date information to help the nurse better understand dia- 
betes mellitus - and to properly educate diabetic patients. 
Emphasizing the care of the aged and children with dia- 
betes. the authors discuss diagnosis, nursing management. 
acute and chronic care. complications. special problems, 
and patient education. Psychosocial aspects are examined 
in depth. March, 1977. Approx. 240 pp., 64 illus About 



ING: A Physiologic Approach. By Judith Amerkan Krueger, 
R.N. MS and Janis Compton Ray. RN. M5. This valuable 
new text provides students with a sound physiologic basis 
for care of patients with endocrine disorders. The autnors 
describe both the function and dysfunction of the pituitary. 
adrenal. parathyroid. thymus. and pineal glands: the pan- 
creas. gonads. and gastrointestinal hormones. Further dis- 
cussions explain appropriate diagnostiC procedures and 
pharmacologic treatments. Many helpful charts summarize 
patient problems and their implications for nursing care. 
August. 1976 175 pp. 41 illus Price, $6.60. 

TEACHING IN NURSING. By Barbara Klug Redman, R.N. 
B.S.N.. MEd, Ph 0 Greatly revised and expanded, this new 
3rd edition presents Important principles and methods for 
patient teaching. Organized around elements of the 
teaching-learning process. this new edition explores: the 
Patient's Bill of Rights: social learning; behavioral objectives 
as educational tools: proposed taxonomy of perceptual do- 
main; and a care plan usmg behavioral modIfication. June. 
1976.282 pp.. 14 figs Price. $8.15. 

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OF INFECTION: A Programmed Presentation. By Betty 
Mcinnes. R.N.. B.Sc.N. MSc.(Ed.). Proceeding from simple 
to complex. this new edition skillfully combines nursing 
management with the study of aseptic principles and control 
procedures as they apply to patients and hospital personnel. 
This new 2nd edition retains the effective programmed for- 
mat of its predecessor with each section updated, ex- 
panded. and clarified. New features include: new headings 
for quick reference; a new glossary; and three new appen- 
dices for summary reviews April, 1977. Approx. 128 pp.. 12 
illus About $6.25. 


We've built a reputation for quality and diversity in nursing publishing. 


M4B 3E5 


The Canadien N urae March 1977 

We've built a reputation for quality 
and diversity in nursing publishing. 


SENTIALS: A Handbook. By Helen Readey, R.N., MS.; Mary 
Teague. R.N., MS.N.; and Wilflam Readey, III, B.S. An ideal 
supplement or study guide, this new text first discusses 
study skills, then devotes an entire chapter to the definition 
and application of the nursing process, emphasizing mas- 
tery of the communication process. The authors also explore 
variOUS systems of charting; legal aspects of nursing; and 
mathematical problem solving. A glossary and learning aids 
are included. April. 1977. Approx. 176 pp.. 19 illus. About 

NURSING CARE: A Model for Practice. By Fay Louise 
Bower, R.N., B.S. MS.N. This thoroughly updated guide to 
planning holistic nurSing care reflects the changing health 
care setting - increased numbers of ambulatory centers 
and home care programs - and emphasizes the nurse's 
responsibility for making independent judgements. New in- 
formation has been added on assessment and the nursing 
diagnosis, and on problem-oriented care plans. March, 
1977 Approx. 144 pp., 9 illus. About $6.05. 
REVIEW OF NURSING. Edited by Dolores F. Saxton, R.N., 
B.S. in Ed., MA, Ed.D.; Phyllis K. Pelikan, R.N., AAS., B.S., 
MA; and Patricia M Nugent. R.N., AAS., B.S., MS.; with 10 
contributors. Field tested for accuracy and updated to reflect 
current concepts and techniques this new edition features 
expanded discussions on medical-surgical nursing, re- 
habilitation and psychiatric nursing nursing history, and the 
physical sciences in nursing. The revised step-by-step for- 
mat is especially helpful to students. January. 1977.624 pp., 
12 illus and 5 two-color illus Price, $13.15. 


Betty S. Bergersen, R.N., M 5, Ed. D.; In consultation with 
Andres Goth, M.D. Written by a nurse for nurses, this popular 
text continues to be the most widely accepted book in the 
field In this 13th edition, it presents thorough, up-to-the- 
minute coverage of pharmacology '. with emphasis On 
understanding drug action in the human body. Two new 
chapters, "Antimicrobial Agents" and "The Effect of Drugs on 
Human Sexuality Fetal D('lIelopment. and Nursing Infant", 
reflect this edition's Increased emphasis on nursing implica- 
tions Virtually every chapter h_s been updated and revised 
to include the latest pharmacological information 1976. 766 
pp. 100 illus Price. $14.20. 

DOSAGE OF DRUGS: Including Arithmetic. By Ellen M 
Anderson, R.N., B.S., MA and Thora M Vervoren, RPh., B.S. 
An effective, self-teaching guide, this workbook relates 
basic mathematics to common solutions and dosages, and 
provides information essential for proper calculation, prep- 
aration, and administration of drugs. Updated throughout, 
the text places more emphasis on the metric system and 
includes many new problems. 1976 176 pp.. 11 figs. Price. 

Workbook. By Ruth K. Radcliff, R.N., MS. and Sheila J. 
Ogden, R.N., B.S. This new workbook is an excellent tool for 
students who want to refresh their knowledge of mathemati- 
cal skills needed to correctly calculate drug dosage. After a 
pretest to determine specific needs, the book discusses 
basics in general mathematics (fractions, decimals, percen- 
tages, ratios, and proportions). Worksheets and chapter 
quizzes assist in the evaluation of learning. January, 1977. 
272 pp., 26 flash cards. Price, $8.95. 


now, Ph.G. B.S., Ph.D., MB., MD. Student-oriented, this 
superb 9th edition clearly delineates the principles of chem- 
ical reactions and their relationships to clinical medicine. 
Chapters have been updated and the appendix contains a 
revised table of atomic weights and numbers. 1976,514 pp., 
225 Illus. Price, $12.55. 

CHEMISTRY. By L Earle Arnow, Ph.G., B.S., Ph.D. MB., 
M.D 1976 102 pages plus FM I-XVI, 5W' x 8W' 43 illustra- 
tions Price, $4 50. 

TRY. By Alice Laughlin, B.S., MS., Ed.D. Clear and com- 
pact. the 12th edition of this popular text continues to relate 
principles to practice in its presentation of the essential 
areas of inorganic and organic chemistry, and biochemistry. 
The book emphasizes the metric system, molecular and 
atomic structure, and recent discoveries in biochemistry 
1976,414 pp., 122 illus. Price. $12.55. 
CHEMISTRY. By Alice Laughlin, B.S.. MS Ed.D 1976 238 
pages plus FM I-XII, 5W' x 8W', 47 illustrations Price 

New 11th Edition! MICROBIOLOGY AND 
PATHOLOGY. By Alice Lorraine Smith, AB, M 0 F G.AP., 
F.ACP. This new edition has been extensively revlf
d and 
updated to answer your students' questions 011 th_ .Jnat's", 
"when's", and "how's" of microbiology with the ost recent 
information available New topics include. serologic diag- 
nosis of protozoal and metazoal diseases, evaluation of 
cell-mediated immunity, immunotherapy, and other related 
subjects April, 1976. 698 pp., 564 illus Price, $16.30 



CARE: Physiology and Technique. By Jacqueline F. Wade, 
R.N., S.C.M., B. T.A. The new 2nd edition ofthis valuable text 
continues to provide your students with an exhaustive pre- 
sentation of respiratory physiology as it relates to nursing 
care. The author places increased emphasis on the applica- 
tion of physiology and nursing therapies to prevent respirat- 
ory complications, and includes more material on specific 
respiratory problems. Two new chapters discuss bedside 
monitoring; and hypoxemia, hYPoxia, and oxygen therapy. 
April, 1977. Approx. 224 pp.. 48 illus. About $7.90. 

WITH BURNS. By Florence Greenhouse Jacoby. R.N. Writ- 
ten by an experienced burn.nurse clinician, this text is a 
concise, yet detai led resource for burn care, from first aid 
treatment to prolonged care of burn patients. Updated and 
expanded, it includes a new chapter on fluid therapy, and 
increased emphasis on pathophysiology, causes, and pre- 
vention of complications. The book reviews fundamental 
facts of anatomy and physiology and provides students with 
a working knowledge of the basic pathologic, physiologic. 
and psychologic changes that can occur in the burn patient. 
Information on the importance of nutrition and special needs 
of young and older burn patients is included. 1976, 198 pp.. 
18 illus. Price. $7.65. 

Reaction and Recovery. By Rue L. Cromwell. Ph.D., et a/. 
This new text presents a compilation of controlled research 
data pertaining to how stress and personality affect a pa- 
tient's recovery from acute myocardial Infarction; and how 
these factors affect the health team's approach to care Prac- 
tical discussions explore such topics as: the patient's re- 
sponse to nursing care; psychological assessment and nurs- 
ing management of coronary patients; and anticipating sub- 
sequent infarctions. March. 1977. Approx. 208 pp.. 24 illus. 
About $11.00. 


NURSING: Social Issues and Trends. Edited by Michael H. 
Miller. Ph.D. and Beverly Flynn, R.N.. Ph.D.; with 21 con- 
tributors This collection of original articles examines sig- 
nificant social issues now confronting the nursing profes- 
sion Written by leading authorities in the field, the book 
focuses on five major topical areas of nursing: ethics, re- 
search, health care delivery, organization. and education. 
Some of the issues discussed include: the establishment of 
the nurse practitioner role; the establishment of nursing un- 
ions as a political force in obtaining improved personnel 
benefits; the creation of professional organizations sensitive 
to nursing's needs; attempts to evaluate educational prog- 
rams; and changes in the issues the ANA is addressing. 
June 1977. Approx. 176 pp.. 4 illus. About $12.10 (C); about 
$8.95 (P). 

Reinhardt, Ph.D. and Mildred D. Quinn, R.N., M.S. This ex- 
ceptional new text offers a variety of alternatives for coping 
with community health situations. Articles range from indi- 
vidualized care to broad concepts in community health ad- 
ministration, including details for planning and implement- 
ing specific programs. The first section of this timely book 
explores current opportunities for community nursing in the 
health field. Further discussions study cultural influences 
and trans-cultural nursing, and then stress the family role, 
focusing on family assessment and effective use of indi- 
vidual family strengths January, 1977. 376 pp.. 30 illus. 
Price: $12.10 (C); $8.95 (P). 
EDUCATION: The Changing Scene. Edited by Jane A. Wil- 
liamson, Ph.D., R.N.. with 18 contributors. 1976, 188 pages 
plus FM I-X, 6 3 ,4" X 9 3 ,4", 12 figures. Price: $11.05 (C); $7.90 


NURSING. Edited by Barbara Holz Peterson. R.N., M.S.N. 
and Carolyn Jo Kellogg, R.N.. M.S.; with 27 contributors. 
1976, 230 pages plus FM I-XVI, 6 3 /.!" x 9 3 /4". 3 illustrations. 
Price: $11.05 (c): $7.90 (P). 
NURSING. Edited by Patricia A. Brandt, R.N., M.S.. Peggy L. 
Chinn, R.N.. Ph.D.; and Mary Ellen Smith. R.N.. M.S.; with 15 
contributors. 1976. 242 pages plus FM I-XIV, 6
" x 9
", 13 
illustrations. Price: $11.05 (C); $7 90 (P). 
PSYCHIATRIC NURSING: Issues and Trends Edited by 
Carol Ren Kneisl, R.N., Ph.D. and Holly Skodol Wilson. R.N., 
Ph.D.; with 24 contributors. 1976, 228 pages plus FM I-XIV, 
4" x 9314". 9 figures. Price: $11.05 (C); $7.90 (P) 

McNall, R.N., M.N. and Janet Trask Galeener. R.N.. MS; with 
19 contributors. 1976.254 pages plus FM I-XVI 6 3 /4" x 9314" 
39 illustrations. Price: $11.05 (C): $7.90 (Pì. 



M4B 3ES 


The Canadian March 1977 


MARN representatives 
meet with cabinet 

The Board of Directors and other 
representatives of the Manitoba 
Association of Registered Nurses met 
with Premier Ed Schreyer and 
members of his Cabinet in 
mid-January, to present 
recommendations on matters of 
concem to the Association. The 
meeting was the first to take place 
between MARN and representatives 
of the govemment of that province. 
A brief presented by MARN 
stressed the Association's desire for a 
continued and regular liaison with 
govemment in matters related to 
health care, particularly as such 
matters affect the delivery of nursing 
The purposes and objectives of 
the Association were outlined with a 
discussion of the ways in which MARN 
is carrying out its objectives. For 
example: registration of members, a 
referral service to assist both nurses 
seeking employment and employers, 
a program presently in progress to 
establish standards of nursing 
practice, continuing education, 
refresher course programs, promotion 
of inservice education, bursaries and 
loans to assist nurses in further 
education, consultation and funds to 
assist in nursing research projects 
were mentioned. 
Brief reference was made to the 
Association's Position Paper on 
Nursing Education: "Challenge and 
Change." Concern was again 
expressed that only one member from 
MARN was permitted to be on the 
Ministerial Task Force appointed to 
recommend on nursing education. 
Resolutions passed at the 
Association's annual meeting were 
also referred to the Cabinet for 
consideration. These dealt with 
learning resource centers for health 
workers; support of non-smoking 
programs and discouraging the sale of 
tobacco in health agencies; legislation 
for compulsory use of seat belts, crash 
helmets, and reduction in speed limits. 
The Association stressed the 
urgent need in Manitoba for nurses 
prepared at the Master's level and 
strongly urged government support for 
the immediate establishment of a 
M.Sc.N. program at the University of 

CNA research study reveals few key changes 
in nursing employment, education patterns since 1966 

The research unit of the Canadian 
Nurses Association has released the 
results of a review of trends in the 
growth and expansion of the nursing 
profession in Canada between 1966 
and 1974. 
Highlights of the study, according 
to research officer, Marion Kerr, 
include the following: 
. Between 1966 and 1974, the 
number of registered nurses 
employed in nursing increased by 56 
percent (from 82,517 in 1966 to 
128,675 in 1974). 
. the field of employment and the 
education levels of nurses working 
during this period did not vary 
significantly from those of the previous 
Increased public and popular 
emphasis on preventive and 
maintenance health services provided 
from community-based agencies and 
the need for higher level s of education 
to prepare nurses to work in these 
settings were not reflected in actual 
practice. In 1974 (as In 1966) more 
than 80 percent of employed 
registered nurses working in 
Canada worked in hospital/ 
institutional settings; more than 80 
percent had as their highest 
academic preparation the diploma 
leading to an R.N. 
Other highlights of the study: 
. the percentage of registered 
nurses employed in community health 
settings remained relatively stable; 
. the greatest shift in level of 
education, a dramatic one from 
diploma leading to R.N. to 
baccalalf"eate degree, occurred 
among registered nurses employed in 
nursing education; 
. the number of registered nurses 
and the number of those holding the 
baccalaureate degree both increased 
by 56 percent; 
. the level of education for 
registered nurses employed as 
directors and assistant directors of 
nursing declined; 
. levels of education for registered 
nurses employed as supervisors and 
head nurses and as general duty /staff 
nurses rose slightly. 

Four questions about the 
employment settings and educational 
preparation of nurses in the period 
between 1966 and t974 were 
investigated : 
Q. Was there a shift towards a larger 
percentage of registered nurses 
being employed in community 
health nursing? - 
A. Rather than a shift towards 
employment in community health 
settings, there was actually a 1.4 
percent decline in the percentage of 
registered nurses employed in 
community health settings. It seems 
clear that although the actual number 
of registered nurses working in 
community health settings did 
increase, the expansion of hospitals 
and other institutions continued to 
absorb the majority of registered 
nurses during this period. 
Q. Was there a shift towards higher 
levels of education for employed 
A. While very little shift occurred 
between 1966 and 1974 in level of 
education of employed registered 
nurses, what shift did occur was away 
from the diploma leading to R.N. 
towards the baccalaureate degree. In 
both 1966 and 1974 over four-fifths of 
employed registered nurses had as 
their highest academic preparation 
the diploma leading to R.N. While 
there was an increase of 2.7 percent in 
the group holding the baccalalf"eate 
degree, there was little change in the 
group holding the master's or higher 
degree and little change in the group 
holding some credits towards a 
baccalaureate degree. 

Did you know ... 
At a meeting held recently in Montreal 
to form the Practitioners of 
Infectious Control in Canada, one of 
the recommendations was the 
formation of local interest groups. One 
such group is forming in the Prairies. If 
you are interested in this field, please 
contact: Laura Black/Jean Harper, 
Continuing Medical and Nursing 
Education, The Plains Health Centre, 
4500 Wascana Parkway, Regina, 
Sask., S4S 5W9. 

Q. Were there shifts in level of 
education towards greater 
preparation for registered nurses 
employed in community health 
A. The greatest shift in level of 
education did not occur in the group of 
registered nurses employed in 
community health settings, but rather 
in the group employed in nursing 
education. Between 1966 and 1974, 
the most prevalent level of education 
for nurse teachers shifted from 
diploma leading to R.N. (29.4 percent 
in 1966) to baccalaureate degree 
(60.6 percent in 1974). In the same 
period the percentage with a master's 
or higher degree more than doubled 
from 5.9 percent to 13.9 percent. The 
second largest shift occurred in the 'I 
group of registered nurses employed I 
in community health settings where 
the percentage of those holding the 
baccalaureate degree approximately 
doubled (as it did in all three fields of 
Q. Was there a shift towards higher 
levels of education among 
registered nurses employed in 
administrative and managerial 
positions,' in general duty, and in 
nursing education? 
A. The greatest shift, an upward one, 
occurred among the group of nurse 
teachers, 60.6 percent of whom held a , 
baccalalf"eate degree in 1974, 
compared to 25.7 percent in 1966. 
Among directors and assistant I 
directors of nursing there was a I 
downward shift in level of education. I 
There was an upward shift in the level ! 
of education of supervisors and head ' 
nurses and the level of education of 
the general duty/staff nurse group 
also shifted upwards slightly. 

. Note: For the purpose of thIS revIew I 
administratIve and managef/al POSItionS comprise 
the positions of director and assistant director of I 
nursmg. and supervisor and head nurse. I 


: Table 1: 

Registered Nurses Employed In Nursing in Canada 
by Field of Employment, 1966 and 1974. 

i Field of Employment 
I Hospital/other institution 
I Community health agencies 1 
, Nursing education programs 
I Other 2 

1966 1974 
80.1 83.8 
11.4 10.0 
3.6 2.8 
4.9 3.4 
100.0% 100.0% 

I Total 
1 2 . 

(n= 82.517) (n = 128,675) 
Community health agencies Include public health, school health, 
occupational health, physician's and/or dentists' office. 
Other includes private duty and other specified fields. 

Table 2: 

Registered Nurses Employed in Nursing in Canada 
by Highest Level of Education, 1966 and 1974. 

Highest level 
of Education 
Diploma leading to R.N. 
Some credits towards a 
baccaJau-eate degree 
Baccalau-eate degree 
Master's or higher degree 






100.0% 100.0% 
(n = 82,517) (n = 128.675) 

Table 3: 

Registered Nurses Employed in Nursing in Canada, by Highest Level of Education and Field of Employment, 
1966 and 1974. 

Highest level Hospital/other Community Nursing education 
Of Education institutions health agency programs 
1966 1974 1966 1974 1966 1974 ., 
Diploma leading to R.N. 88.8 86.4 72.8 59.4 39.9 11.2 
Some credits towards a 
baccalaureate degree 7.8 8.1 17.9 23.9 24.8 14.3 
Baccalaureate degree 3.2 5.3 8.6 16.0 29.4 60.6 
Master's or 
higher degree 0.2 0.2 0.7 0.7 5.9 13.9 
Total 100.0% 100.0% 1000% 100.0% 100.0% 100.0% 
(n = 66,172) (n = 107,769) (n = 6,834) (n = 12,844) (n = 2,932) (n = 3,427) 

Table 4: Registered Nurses Employed in Nursing in Canada by Highest Level of Education and Position, 1966 and 1974. 
Hig hest level Directors and SupervIsors & General Duty / 
of Education Assistant Directors Head Nurses Staff Nurses Nurse Teachers 
of Nursing 
1966 1974 1966 1974 1966 1974 1966 1974 
Diploma leading 60.1 62.6 84.3 78.8 88.4 86.2 42.7 11.2 
to R.N. 
Some credits towards 
a baccalaureate 
degree 15.2 14.7 11.4 13.7 8.2 8.5 27.5 14.3 
Baccala ureate 
degree 19.3 18.0 4.1 7.1 3.3 5.3 25.7 60.6 f 
Master's or 
higher degree 5.4 4.7 0.2 0.4 0.1 0.1 4.1 13.9 
Total 100.0
/o 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 
(n = 2,549 (n = 3,735ì (n = 14,894) (n = 21,207) (n = 54,906) (n = 96,793) (n = 3,053) (n = 4, 720) 

14 The Canadian N.... "arch li77 
,... ..... 
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Designed to reduce 
lint and debris problems. 
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this )

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Care can be provided day or 
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For complete information on our 
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CNA Directors hold Work Session 
to consider nursing directions 

Jirectors of the Canadian Nurses 
!\'ssociation have come up with a list of 
ive major recommendations for action 
)y the nursing profession. The list 
ncludes a recommendation 
::onceming the development of a 
:iefinition of nursing practice. 
The recommendations were 
jipproved at a special Wo
':;ailed by CNA Directors to discuss 
,'Regulation of the Profession: 
ursing Directions - Power and 
I;:)urpose." The session took place in 
:Jttawa in mid.January and was 
:!ttended by members of CNA's Board 
I)f Directors and advisers to the 
CNA president Joan Gilchrist, 
who was chairman of the session, 
loted that directors had agreed at 
their last meeting of the Board that 
regulation of the profession must be 

onsidered a priority throughout the 
'1976-78 biennium and had expressed 
I::oncern over the fact that the control 
and delivery of nursing services were 
Ibeing shaped by people outside the 
nursing profession. They had 
:expressed the desire to meet to gain 
first-hand information on what was 
Ihappening in nursing and health 
Iservices across the country so that 
they could identify problems, propose 
istrategies and identify ways that CNA 
,could assist in solving these problems. 
;During the wo
 session a 
:representative from each of the eleven 
Iprovincial territorial member 
lassociations made a verbal 
:presentation identifying issues and 
Iconcerns within their region. 
I The five recommendations 
lapproved were: 
:. that a definition of nursing 
'practice be developed. 
. that the Executive Committee (a) 
review the CNA Position Statements 
land CNA Publications in the light of 
:issues discussed, (b) make necessary 
'revisions or proposals, and (c) report 
:back to the next Board of Directors 
,. that a discussion paper be 
!prepared on principles, alternatives, 
" implications and strategies related to 
registration/licensure by the 
,provincial nurses' associations. 

. that the two consultants in Labor 
Relations Services give priority to 
preparation of a draft statement for the 
Executive Committee outlining the 
role of union vis a vis the role of the 
professional association. 
. that the Executive Committee 
study the feasibility of initiating a draft 
paper on the delivery of health care 
services with a view to developing a 
statement on the delivery of nursing 
services independently and in 
conjunction with professionals and 
others in the health care system; that 
the Executive Committee use CNA 
members and/ or consultants to obtain 
needed data and that current CNA 
papers in delivery of service and 
related documents be utilized; that 
projections for future delivery of 
nursing services be included. 

MARN supports Alert 

A recent demonstration of Heart Alert 
(Heart and Lung Emergency 
Resuscitation Training) was 
enthusiastically received by the 
Manitoba Association of Registered 
Nurses' Board of Directors and 
presidents of MARN Chapters. The 
Heart Alert demonstration, presented 
at a recent Board meeting by Eleanor 
Wilson and Dr. W.A. Tweed, teaches 
people to deal effectively with cardiac 
emergencies by education in coronary 
risk factors, recognition of the signals 
of heart attack, emergency action for 
survival, cardiac first aid, and training 
in cardio-pulmonary resuscitation for 
hospital and community emergency 
rescue personnel. 
The program is sponsored by the 
Manitoba Heart Foundation and has 
received the support of many of the 
health care disciplines. Follow-up 
cases show that lives have been 
saved through emergency cardiac first 
aid. administered by persons trained 
in the advanced techniques of this 
lifesaving program. In order to bring 
information about this program to its 
members, MARN is planning 
meetings at chapter, district, and 
provincial levels. 

UWO Dean of Nursing addresses 
Seneca College Education Day 

Nurses in Canada are going to have to 
make some tough decisions in the 
next few years in order to continue to 
grow and develop as a profession and 
to meet the expectations of both 
employers and consumers of health 
care. The decade coming up, 
according to Josephine Flaherty, 
Dean of the Faculty of Nursing at the 
University of Western Ontario is one of 
decision and it is up to nurses to meet 
this challenge from within the 
profession. "Nurses hold the future of 
nursing in their hands," she says. 
Flaherty, who was addressing 
more than 200 nurses on the occasion 
of Education Day at Seneca College of 
Applied Arts and Technology in 
Toronto, paid tribute to the 
accomplishments of nursing leaders 
during the last fifty years. As a result of 
their efforts, she said, nurses in 
Canada show a new level of matunty 
and are better prepared than ever 
before to participate in the 
decision-making that will be required. 
She called on nurses as a group to 
prepare themselves for peer review 
since "a profession monitors its own 
members" and "we as nurses are the 
experts in the practice of nursing." 
"Many nurses. " she pointed out, 
"are allowing their practice to be 
controlled by the expectations of 
others, including members of the 
medical profession and administrators 
in the hospital and educational setting. 
As nurses. we must define nursing 
practice and develop and implement 
ways of recognizing excellence in that 
practice among our own members." 
Often, according to Flaherty 
we, accept the principle of maintaining 
competency without recognizing it as 
"a way of life." She described 
compulsory continuing education as 
neither philosophically acceptable nor 
practical at this time in Ontario but 
pointed out that it is only by making a 
voluntary commitment to continuing 
education that an individual can 
encourage and assess his own needs, 
explore available resources, develop 
and grow to meet the challenges of a 
dynamic profession. 

Flaherty is a past president of 
the Registered Nurses Association of 
Ontario and a former member of the 
Board of Directors of the Canadian 
Nurses Association. Her address set 
the tone for the six wo
 sessions that 
were also featured on the program for 
Education Day at Seneca College 
Nursing Division. The event, which 
was first held in 1968, is an annual 
affair, open to nurses from all the 
hospitals and community agencies 
where Seneca College nursing 
students obtain their clinical 
experience. Donna Wells, Chairman 
of the Nursing Division. describes it as 
"one way of helping to bridge the gap 
between education and service." 
Discussion leaders for the 1977 
Education Day included: Primary 
Nursing - Gail Ouellette, North Yo
General Hospital; Pat Keams, 
Sunnybrook Hospital; Pat Harries, 
Toronto General Hospital; Nursing 
Care Planning - Cathy Cameron, 
Seneca College; The Discipline 
Hearing - Helen Evans, North Yo
General Hospital; Dealing with Stress 
- Elaine Wood and Pat Hall, Seneca 
College; The Professional and 
Unionism - Adeline Jack, RNAO; 
Kidney Transplant - Kathy Janzen. 
Seneca College. 


Did you know... 
Living with End-Stage Renal Disease. 
a new, 45-page booklet. provides 
technical information about dialysis 
and kidney transplant surgery in 
layman's language. Single copies 
available without charge from 
Technical Services of the Bureau of 
Quality Assurance. 5600 Fishers 
Lane, Rockville. Md., 20852. Multiple 
copies at $1.10 purchased from the 
Supenntendent of Documents. U.S. 
Govemment Printing Office, 
Washington, D.C.. 20402. 




The CanadIan March 1977 

CUNSA delegates meet in Calgary 
to examine nursing and the law 

Debi Parish 
More than 240 student nurses 
representing 20 university schools of 
nursing from across Canada attended 
the annual CUNSA conference held 
this year at the University of Calgary, 
in Calgary, Alberta from February 3-6. 
The Canadian University Nursing 
Students Association (CUNSA) is a 
national organization for Canadian 
nursing students in baccalaureate 
programs. Their annual conference is 
aimed at promoting student interest in 
nursing activities, and gives members 
an opportun ity to share their ideas and 
enthusiasm, and keep up-to-date with 
the latest advancements in nursing. 
This year, the official welcome 
was extended to all university 
representatives by Dr. Cochrane, 
President of the University of Calgary. 
The theme of the conference, "The 
Nurse and the Law," introduced by 
Margaret Schumacher, Dean of the 
Faculty of Nursing at U. of C., was 
discussed by a panel composed of: 
J.P. McLaren, Dean of the Faculty of 
Law, U.of C.; Myrtle E. Crawford, 
Assistant Dean of the College of 
Nursing, University of Saskatchewan; 
Janet KelT, Professor of Nursing, U.of 
C., and co-author of Contemporary 
Issues in Canadian Law for Nurses; 
and the Honorable Mr. Justice Tevie 
H. Miller. 
A discussion held on Saturday 
focused on the question of euthanasia 
and the implications for nursing. An 
excellent film entitled "Whose Life is it 
Anyway?" prompted lively discussion 
and debate among those attending. 
Elections for the new members of 
the national executive took place on 
Saturday afternoon. The newly 
elected chairperson is Peggy 
Wareham, Memorial University, St. 
John's, Newfoundland, who replaces 
Ingrid Fell, the outgoing chairperson 
from McMaster University, Hamilton, 
Ont. The new national research 
coordinator is Mary Comer, Mount St. 
Vincent University, Halifax, N.S. Both 
Peggy and Mary plan to attend the 
International Council of Nursing (ICN) 
conference in Tokyo in May. 

Representatives were also elected 
from the three regions - the West, 
Ontario/Quebec, and Atlantic regions. 
Regional chairpersons are: Ellen 
Thom, University of Calgary, Diane 
Thompson, University of Toronto and 
Ann Peters, Dalhousie University in 
Halifax. Regional research 
coordinators are: Debbie Gibson, 
University of Calgary, Jeanette Ross, 
University of Toronto and Cathy 
Toner, Dalhousie University. 
Although business meetings and 
discussion of nursing issues was a 
large part of the three-day conference, 
there was time too for socializing and a 
trip to Banff. Next year, the national 
conference will be held at the 
University of Western Ontario. in 

Did you know... 
The University of Alberta has 
individual study program packages 
entitled Emergency Care for Nurses 
in Smaller Hospitals and Coronary 
Care. The programs take 20 hours to 
complete and are available for $50/ 
package (materials for four), $2./ 
additional participant. For information 
contact: Continuing Education, 
School of Nursing, Clinical Sciences 
Building, University of Alberta, 
Edmonton, Alberta, T6G 2G3. 

Lifestyle Award 
Program Announced 

Health and Welfare Minister Marc 
Lalonde recently announced details of 
a program created to acknowledge the 
contribution made by Canadians in the 
promotion of positive health lifestyle in 
their communities. 
In announcing the new program, 
Lalonde indicated that while the main 
purpose of the Lifestyle Award is to 
bring recognition to individuals who 
have worked for years, often 
unrecognized, to raise the level of 
health awareness in their community, 
it is hoped that it will also serve to 
reinforce voluntary action among 

Deserving persons may be 
nominated by individuals living in their 
community, by community 
organizations, national and provincial 
associations or municipal 
Nominees should have actively 
given of their time and energy on a 
volunteer basis to the improvement of 
health habits in the community or had 
significant involvement in the 
provision of health-related facilities or 
services. These projects should have 
been undertaken for a considerable 
period of time and had a significant 
impact on membersofthe community. 
Nomination forms are available 
by writing to the Secretary, Lifestyle 
Award Committee, Ottawa, KIA OK9. 

Did you know... 
Bell Canada's announced intention of 
gradually replacing all telephone 
receivers with ones that do not create 
an electromagnetic field was the 
subject of protest by CNA members at 
the last annual meeting. Members 
pointed out that certain types of 
hearing aids equipped with a telecoil 
or telephone switch, need an 
electromagnetic field to function 
Now, Bell Canada has decided to 
maintain the electromagnetic field in 
telephones in the homes or worn 
locations of hearing-impaired users 
and in public telephones. 
Researchers will also look into ways to 
make hearing aids compatible with all 
types of telephone receivers. 

Moving, being married? 
Be sure to notify us in advance. 


Attach label flom 
your last issue or 
copy address ana 
code number from it here 

New (Name)/Address 




Postal Code/Zip 

Please complete appropriate category 
D I hold active membership in provincial nurses' assoc. 

reg. no.lperm. cert./lic. no. 

D I am a personal subscriber 
Mail to: The Canadian Nurse, 50 The Driveway. Ottawa K2P 1 E2 

. , - . . . , - 
therapy I 
for both . 
vaginal candidiasis 

-- J 



Vaginal Tablets 




. for pregnant and non-pregnant women in dermatology 
. low relapse rate Cream/Solution 

The broad spectrum approach to vaginitis 
due to candida, trichomonas or mixed infections. 

. fungicidal and trichomonacidal action 
. convenient once-a-day, 6 day therapy 

. no cross-resistance with other agents 
. no known contraindications 

instant therapy 

. _=___.. 1- _ 

. for the topical treatment of 
both tinea and candidiasis 


. well tolerated 
. excellent patient acceptance: 
non-staining, non-greasy, odourless, 
rapid and complete disintegration 
of vaginal tablets. 



, l t n. . 


. when your patient can't wait 
for time-consuming culture 


Years ago, most ostomates went home with a so-called "permanent" appliance, The 
disposables available then were mainly for post-op use. Now, though, there's a 
family of simple, convenient disposables your patient can wear home with confi- 
dence. These Hollister disposables offer all you'd expect of "post-op" appliances: 
lightness, one-piece construction, ease of handling. Yet they're Itrong-made of a 
tough multi-layered film that holds back odor more than 200 times as effectively as 
common polyethylene plastic, Thousands of ostomates who were started with 
Hollister disposables In the hospital have gone right on using them as their full-time 
appliances. Your patients can, too. 




tt -- 

. ,.-" 


Send her home confident. 
An odor-barrier Karaya Seal stoma 
bag will provide 
skin protection, 0 - 
security, and 
simple self-care 
until her 
colostomy is 
regulated. And 
Hollister's ver- 
satile, mess- 
Irrigator Kit offers an easy way to 
establish her irrigating routine. 



Send him home secure. 
Specify a Karaya Seal Drainable- 
the disposable 
that provides 
effective skin 
without elaborate 
skin preparation, 
It fits snugly 
around the stoma, 
sealing off skin 
from potentially excoriating 
discharge, yet is easy to put 
on, easy to empty, and easy 
to dispose of. 

Write on professional or hospital letterhead. 

There'a a Holhaler Producllo aimpli/y 
every aloma-cllre laak 

01'" ., nULL':'>'"'' 
'-U" U.... 

) ) 


.... "" .. --- 

Spare her the faceplate-cement- 
solvent routine. 
Urostomy Bag 
appliances by 
Hollister. These 
one-piece dis- 
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convenient drain 
valve for ambula- 
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bedside drainage, 
and do away with 
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most "permanent" appliances 


A Question of Balance 

Lynda Ford 

The Effects of Chronic Renal Failure 
and Long-term Dialysis 

RT 1 

To anyone who knows Stephen, his 
tears and depression are 
understandable. For him, chronic renal 
failure has meant some pretty drastic 
changes - a change in career goals, 
loss of financial independence, and 
emotional instability. After a year and a 
half on hemodialysis, he feels 
threatened by constant illness and 
complications, and by his dependence 
on a 'machine' to maintain his life. 

If you are a nurse working outside 
a dialysis or transplantation unit, the 
chances are that the image evoked by 
the 'chronic renal patient' isn't too 
favorable. Unfamiliar with the world in 
which he lives, you may be only too 
willing to stereotype Stephen as 
mistrustful, demanding and 
manipulative, or as apathetic and 
unresponsive to your efforts. But 
supporting Stephen depends on the 
time you take to understand ... 

I I 
, ........................................................................................................ 


20 The Canadian N....e March 1977 I 
......... ............ . .. .............. ................ ................. ........... - . .................... "' f 
Chronic Renal Failure _ 
Chronic renal failure ma y be the result of . 
 ;".., . III .. 
one of several disease processes that cause . 

. , 
loss of kidney function for variable reasons. '.' " t '. ..: . ,ii,t. 

Among these causes are: .' 
. Primary Glomerular Disease - ,,.:. /.\"Ø. }\
, ,,' " ." t. " 
. Infection - pyelonephritis, tuberculosis .... ).: 
(. t:.,'J, 
· Collagen Disease - disseminated .. . :
 ,.iJ; /", . \.. . 1 ,1 .....t . 
 . .
lu p us e ry thmatosis, scleroderma .') 
"'. "'1.\' .'1\, 
. Obstruction - bilateral renal calculi, yf,J ,,' 'J . 
prostatic obstruction, neoplasms J\...:;';( 1,.:
' "t'L. 
. Congenital Disease - polycystic . ......r
disease, medullary cystic disease 
. Hypertensive Nephropathy - malignant 
and non-malignant hypertension 
. Toxic Nephropathy - chronic 
phenacetin abuse 
. Systemic Disease - diabetes mellitus, 
gouty nephropathy, amyloid disease. 

Stephen Davidson was first admitted to 
hospital in September of 1972, at the age of 
twenty-two, because of problems with 
recurrent epistaxis and hypertension. At the 
time, he was a student in business 
administration at a local university. Stephen 
had no past history of renal disease. On 
admission, he was diagnosed as having 
hydronephrosis secondary to reflux, and 
surgery was done to allow direct urine 
drainage of the kidney pelvices (bilateral 
nephrostomies) . 
In 1973, Stephen was admitted to hospital 
several times for treatment to control his 
hypertension. By February of 1974, in 
end-stage renal failure, he began 
hemodialysis and was considered as a 
candidate for kidney transplantation. 
End-stage renal failure is a condition 
affecting approximately 1000 Canadians each 
year. Regardless of its etiology, what the 
condition means to the patient is that his 
kidneys can no longer excrete body wastes, 
that these wastes accumulate in the 
bloodstream (uremia), that the balance of 
electrolytes in his body is severely disturbed, 
and that withouttreatment, he will die. Medical 
and nursing management then is directed 
towards providing for removal of body wastes, 
artificially maintaining a better balance in body 
systems, and supporting the patient through 
the changes that alter his whole way of life. 
Stephen began hemodialysis in a state of 
considerable anxiety. At the age of 23, the 
irreversible nature of his condition seemed 
more than he could handle. His uremic state 
meant that he was fatigued, lethargic, and 
weak, augmenting his inability to deal with the 
stress of his illness and its treatment. He was 
very emotional, crying frequently. He 
discussed his fears frankly with the nurses and 
doctors in the renal unit and with his family- 
there seemed to be so many things to be afraid 
of. Stephen's family was close to him, and 
openly supportive, but unfortunately lived in a 
town 100 miles away from the hospital where 
he was being treated. Until August of 1973, 
Stephen was dialyzed through an 
arteriovenous cannula in his left leg. 

In Stephen's case, reflux of urine into the 
kidneys caused distention of the kidney 
pelvices and calyces, resulting in atrophy of 
the kidney parenchyma, a condition called 
hydronephrosis. Decreased renal function 
resulted because of increased pressure on the 
kidney tissue, and hypertension. 
Hypertension can lead to kidney disease; 
conversely kidney disease can cause 
hypertension ... Fluid retention associated with 
kidney disease contributes to hypertension. 
Damaged kidneys also tend to secrete 
increased amounts of renin, resulting in an 
augmented aldosterone secretion which 
causes retention of fluids and electrolytes, and 
consequently hypertension. Hypertensive 
nephropathy - further kidney damage 
because of inadequate blood supply to the 
kidneys - may result. 
Loss of kidney function as a result of any 
of the causes mentioned may be partial or 
complete. Stephen suffered complete and 
irreversible loss of kidney function. More 
recent ways of dealing with patients in 
end-stage renal failure include dialysis and 
transplantation. Stephen was hemodialyzed 
until akidney was available for transplantation. 
In spite of the relative success of dialysis 
as a treatment measure for patients in 
end-stage renal failure, it must be 
remembered that until successful 
transplantation, uremia continues to effect not 
only an imbalance in fluids and electrolytes 
and the excretion of body wastes, but that it 
causes changes in the organ systems as well, 
altering almost every aspect of normal body 

It is easy to see that the negative effects of 
uremia on body balance are comprehensive, 
that the stresses imposed by the condition are 
beyond anyone's capacity to accept without 
the greatest difficulty. First of all, he must deal 
with the fact that he exists with a condition that 
is life-threatening, and that choices for 
treatment are not without their own drawbacks 
and complications. 
Physically, the patient feels fatigue, and 
apathy; generally he feels ill. The feeling of 
illness often continues throughout dialysis. 
Often, he must change his lifestyle, his job, his 
goals. There may be financial problems as a 
result of his chronic ill-health and the necessity 
for dialysis. His whole 'self-image' is 
The patient's reliance on dialysis to 
maintain his life may lead to many conflicts - 'I 
he may feel discouraged by his dependence, 
confused by the fact that he is encouraged to 
maintain independence. His confusion may 
express itself in many ways: overdependence 
on medical staff and complete assumption of 
the sick role, and overt rebellion against the 
necessary restrictions inherent in his 
treatment regime are two extreme behaviors 
that can indicate this confusion. 
When Stephen began dialysis, he was still 
attempting to keep up his university courses, 
although it presented many difficulties for him. 
His anxiety was continually expressed through 
emotional outbursts. It wasn't long before he 
began to develop cannula infections and other 
problems associated with dialysis. 
By June of 1974, he had given up his 
courses at the university and had begun 
training as a hair stylist. This course allowed 
him to put in as many hours as he felt up to. He I 
was on Social Allowance with a supplement I 
from Manpower to help him out financially. ! 
It was at this time that Stephen began to 
express that he desperately wanted 
"'freedom" from his dependence on the 
machine, a kidney transplant, and the chance 
for a normal lifestyle that it offered. He also 
began training on the home dialysis program in 
the hospital in June. After six weeks on the 
home dialysis program, he was at least able to 
dialyze himself at home. I 


, ..... ................................................................. 

I. Imbalance in Body Chemistry 
I Blood tests of the patien
 will indica
e a 
se in the products of protein metabolism: 
lood urea nitrogen (BUN), creatinine and 
ric acid. The patient's BUN fluctuates, 
,fluenced by a number of factors: renal 
Jnction, dietary intake of protein, rate of 
'rotein catabolism, rate of urea synthesis, and 
Ie patient's state of hydration. Serum 
. reatinine, the end product of creatine, an 
Imino acid present in body tissues 
3specially muscle) is a more reliable indicator 
,f renal function, as it is less variable. 
I Hyperkalemia, an increase in serum 
.>otassium. is chiefly due to the disability ofthe 
:idneys to excrete potassium. Serum 
')otassium can rise to dangerous levels in the 
'!remic patient. Serum potassium levels may 
1Iso be abnormally low in uremic patients as a 
esult of gastrointestinal losses (vomiting, 
Serum sodium levels may also be 
Jisrupted in uremic states. The kidneys cannot 

xcrete sodium, and a patient's failure to 
Idhere to dietary restriction of sodium may 
'.esult in increased serum sodium 
,hypernatremia) and water retention. Low 
';odium values (hyponatremia) occur through 
astrointestinal losses and increased 
Serum calcium levels are low in uremia 
:>ecause of a decreased absorption of calcium 
From the gut, and in association with an 
elevation in serum phosphate levels. 
Calcium/phosphate imbalance disturbs 
the function of the parathyroid gland. Because 
of a decrease in serum calcium, the 
parathyroid secretes additional parathyroid 
hormone in an attempt to restore serum 
calcium levels to normal. Secretion of further 
parathyroid hormone as a result of hyperplasia 
of the parathyroid gland may eventually cause 
,elevated serum calcium levels by stimulating 
Ireabsorption of calcium from the bones. Bone 
:disease, a common problem in uremic 
!patients, is related to the imbalance in serum 
calcium, serum phosphate and parathyroid 
Igland function. 
, Serum magnesium rises in uremic 
: patients due to the inability of the kidneys to 
i excrete magnesium. Low serum magnesium 
; levels are the result of losses through vomiting 
and diarrhea. 
! Metabolic acidosIs occurs in the patient 
,with uremia because his kidneys cannot 
I excrete acid as ammonium. 
i Because of the disability of the kidneys to 
: dilute urine, the patient's water load cannot be 
,excrp.ted rapidly or adequately resulting in 
fluid overload. 
O. Imbalance in the Respiratory System 
Uremic patients have an increased 
I susceptibity to infection, and a prime site for 
I infection is in the lungs. Pulmonary edema 
I may result from fluid overload and congestive 
, heart failure. Intrapulmonary bleeding is 
I possible as a result of the impaired platelet 
i function associated with uremia. The patient's 

respiratory rate may increase to compensate 
for his acidotic state. 

O. Imbalance in the Cardiovascular 
Hypertension occurs in a large 
percentage of patients with irreversible renal 
failure. As a consequence of kidney damage, 
the kidney secretes increasing amounts of 
renin, resulting in rising aldosterone secretion 
and thus retention of fluid and electrolytes. 
Hypertension is the result of this process, and 
in turn it may cause cerebral vascular disease, 
coronary heart disease, and congestive heart 
fail ure. 
Congestive heart faHure is often 
associated with hypertension and fluid 
retention in the uremic patient, and it may 
result in pulmonary and generalized edema. 
Pericarditis also occurs with uremia. 
although the causes are unclear. Cardiac 
tamponade may follow. 
Cardiac arrythmias are often related to 
elevated serum potassium and serum 
magnesium levels. Elevated serum 
magnesium and potassium levels may result 
in cardiac arrest. 

O. Imbalance in the Hematological 
Most patients with chrome renal failure 
are anemic. Normal hemoglobin readings may 
ride between 6-8 gm/ 100 mi. The normal 
kidney secretes erythropoietin, a substance 
that stimulates the bone marrow to produce 
red blood cells. Patients in chronic renal failure 
secrete inadequate erythropoietin, and the 
result is a decrease in red blood cell 
production. Red blood cells tend to show a 
shortened life span in patients with elevated 
BUN levels. 
Uremic patients also have a tendency to 
bleed, probably related to a defidency in the 
number and quality of platelets. 

O. Skin Changes 
Changes in the skin are uncomfortable for 
the patient in uremia. 
Pruritis is severe. The skin is generally dry 
and scaly due to calcium/phosphate 
imbalance. If the patient scratches iichy skin, 
the scratches do not usually heal well, and the 
possibility of infection is great. 
Skin color changes, becoming sallow 
yellow-brown to gray in pigmentation. Anemia 
gives rise to pallor. 
Clotting abnormalities make bruising and 
petichiae common. Perspiration generally 
decreases. Nails become brittle and thin, hair 
is dry and may fall out. 


O. Imbalance In the Gastrointestinal 
Gastrointestmal bleeding can occur 
anywhere along the GI tract in patients with 
uremia, perhaps due to defective clotting 
mechanisms (platelet defidency). Anorexia, 
nausea and vomiting are common in uremic 
patients. and contribute to weight loss, and 
further electrolyte imbalance. Decreased 
salivary flow, dehydration, and mouth 
breathing (addosis) may result in parotitis or 
stomatitis. The patient may also complain of a 
metallic taste in his mouth, loss of smell, and 

O. Imbalance in the Neurological System 
The nervous system of the patient in 
uremia is affected in a comprehensive way. 
Mental function can be sluggish, marked 
by apathy and an inability to concentrate, 
limitations in attention span, and confusion. 
Coma and convulsions may occur. 
Personality and behavior changes in the 
patient with renal failure are remarkable. 
These include increased initability, emotional 
lability, depression and withdrawal, agitation, 
demanding behavior, and complete lack of 
cooperation. Psychosis with hallucinations 
may develop. 
Peripheral neuropathy may reveal itself in 
numbness or burning of extremities and 
slowed reflexes. Muscle changes may include 
twitching, tremulousness, nocturnal cramps, 
and atrophy. 
O. Skeletal System and Bone Disease 
Because of changes in the calcium, 
phosphate and parathyroid balance, bone 
disease is a problem for uremic patients. 
Bone pain, joint calcifications and 
fractures occur. Repair mechanisms in bone 
disease cause an increase in serum alkaline 
phosphatase levels. If serum calcium and 
phosphate levels are high, soft tissue 
calcifications may occur. 

O. Reproductive Ch
Chronic renal failure means reproductive 
changes in both men and women. Male fertility 
decreases with a rise in serum creatinine. 
Impotence is a major problem. Amenorrhea 
occurs in women. Both men and women 
indicate a decrease in libido. 
Chronic renal failure patients also have an 
increased susceptibility to infection. Now that .. 
dialysis treats kidney failure itself, infection is : 
the major cause of death in uremic patients. A : 
change in antibiotic metabolism makes : 
infection difficult to treat Uremia is also · 
ociated with slow wound healing. : 


22 The Cenedlen N.... Merch 1871 I 
.......................................................... ............................................ .... 


.What happens in dialysis 
The healthy kidney eliminates waste 
products and maintains fluid and electrolyte 
balance in the body through filtration in the 
. Medications glomeruli and reabsorption and secretion in 
Medications for the patient on dialysis for the tubules. Filtration, osmosis and diffusion 
chronic renal failure attempt to make up for are involved. When these functions are 
body balance interrupted by uremia. They may disturbed, dialysis is the means of elimination 
include: of wastes and maintenance of electrolyte 
. phosphate binding agents-aluminum balance. 
hydroxide products, such as amphogel, keep In peritoneal dialysis, the peritoneal 
phosphate from being absorbed into the membrane is used as a dialyzing membrane to 
bloodstream, and help to deter a further rise in remove nitrogenous wastes and to 
serum phosphate levels. None of the restore to normal body fluids and 
prescribed medications contain magnesium, electrolytes. Osmosis, diffusion and filtration 
and the patient must realize that he cannot occur across this membrane, between the fluid 
substitute magnesium products as his kidfleys introduced into the peritoneal cavity I 
cannot excrete magnesium. (dialysate) and the blood supply of the 
. vitamins - multivltes and folic acid are abdominal organs. Patients on long-term 
necessary to supplementthe dietary source of peritoneal dialysis (or home peritoneal 
vitamins, because dietary restrictions are dialysis) have indwelling silastic catheters 
comprehensive, and because water-soluble inserted in the peritoneal cavity and these can 
vitamins are dialyzed out. Vitamin D is often be expected to last for years. Dialysate is 
prescribed as it helps to absorb calcium from introduced into the peritoneal cavity via the 
the digestive tract, and thus to prevent bone catheter, stays there for a short period of time, 
disease. is then drained out, and a new cycle is begun. 
. Diet . anticoagulants - such as coumadin Automatic peritoneal dialysis machines allow 
In the past, dietary restrictions have been may be prescribed to decrease platelet the patient to sleep while dialysis is taking r 
severe. Now, in most cases, restrictions are adherence or clotting, thus maintaining place. 
moderate, the patient's ability to live with his patency of an arteriovenous shunt. One of the drawbacks to peritoneal 
diet being considered as a major factor in its . iron - ferrous gluconate may be given dialysis is the time involved in the procedure. 
success. But the diet cannot be abused intravenously to build serum iron, and Generally patients using this method must be 
without consequence, and in this way is similar counteract anemia. on dialysis for 40 hours per week. Problems 
to prescription medications for the patient In . PRN medications - antihypertensives with infection (peritonitis) used to be a 
chrl'nic renal failure. may be necessary where hypertension is a considerable drawback to peritoneal dialysis, 
Generally, patients on hemodialysis are problem. but now infections are much fewer in number. 
allowed a weight gain of 1.5 kg between -laxatives may be necessary because of the Peritoneal dialysis causes protein 
dialysis treatments. Daily fluid intake often constipating effect of aluminum hydroxide. depletion, which can be alleviated by 
consists of 500 cc plus the previous day's urine Only prescribed laxatives are to be used by the increasing dietary protein. The procedure 
output. The use of alcohol is restricted patient, and magnesia is not to be taken. cannot be used if the patient has abdominal 
because of its adverse effects on blood - valium may be necessary for anxiety adhesions. 
pressure, and because it usually means an - antibiotics may be needed periodically for Some advantages to peritoneal dialysis: it 
increase in fluid intake. Obese patients are treatment of infections. The use of many is simpler, and easier for the patient to initiate 
calorie restricted. antibiotics is restricted because of altered and terminate than hemodialysis. Many 
Sodium, potassium and fluids are antibiotic metabolism. patients are now involved in home peritoneal,1 
restricted and monitored, the patient's weight, When he began dialysis, Stephen was on dialysis programs, which normally involve a 
blood pressure, BUN and creatinine levels a 2 gm Na, 60 mEq K, 60 gm protein diet. two to three-week training period before the 
being the indicators for restrictions. Protein is Because his daily urine output was 1500 cc, he patient is ready to dialyze himself at home. I 
also restricted because the products of protein was allowed 2000 cc fluid in 24 hours. His Hemodialysis involves circulation of the 
metabolism are not excreted normally. The medications included folic acid 5 mg q.i.d., patient's blood from an artery through a 
importance of intake of high quality protein, cloxacillin 500 mg q.6.h. (for a cannula dialysis machine, and back into the patient Vié 
with essential amino acids for body building infection), and valium pm for anxiety. He was a vein. The artificial kidney eliminates waste! 
(found in eggs, milk and meat) is emphasized also on phosphate low cookies (containing products from the blood by filtration and j 
in dietary teaching. aluminum hydroxide) t.i.d. with meals. diffusion across a semipermeable membrane I 
......................................................................................................... II 

. Treatment of Chronic Renal Failure 
With improvements in the techniques of 
dialysis, patients can now be dialyzed more 
effectively. In addition to dialysis, the uremic 
patient must adhere closely to restrictions in 
fluid intake and diet, and to a medication 

. ....................................................................................................... 

6. Beginning dialysis. 3 
L he patient's blood flows within a 
/;emipermeable membrane and the dialyzing 
luid flows on the outside of the membrane, 
,jrawing out wastes from the blood. 
-Iemodialysis is done three times a week for a 
Jeriod of three to seven hours each time 
jepending on the patient's body size and 
3dherence to diet and fluid restriction. In many 
::enters, patients are involved in home 
lemodialysis programs in order to leam to 
/jialyze themselves in their own homes. 
I Repeated hemodialysis necessitates 
leasy access to the patient's bloodstream 
Ilhrough a shunt. Several types of access are 
Jused, the main types being silastic cannulas 
'and subcutaneous arteriovenous fistulas. 5 
:Both of these methods allow shunting of blood 
,from an artery to a nearby vein. With a cannula 
'the patient's arterial blood flows through 
'silastic tubing into a vein, whereas a fistula 
I involves surgical anastomosis of an artery and 
a vein. Grafts are used when the patient's 
I vessels don't provide adequate access. 
, When the patient has a cannula, the 
connection in the shunt is opened for dialysis 
and the arterial tubing is attached to the tubing 
leading to the dialyser. The venous tubing is 
attached to the tubing leading out of the 
I dialyser. Shunt failure may arise due to clotting 
or infection. If these cannot be remedied, a 
new site must be chosen for the shunt. 
I The cannula offers painless, easy access 
to the patient's bloodstream. However, it .Why transplantation . dialysis disequilibrium syndrome- 
requi res some care. The cannula is external, Improvement in the techniques of dialysis This is thought to occur because removal of 
and accidental separations can occur. and the possibility of home dialysis have urea nitrogen from the blood occurs at a rate 
Dressings must be done to guard against allowed patients in end-stage renal failure to relatively rapid to its removal from the brain. 
infection. keep up jobs and have reduced the necessity Reverse osmotic gradient pulls fluid into the 
The AV fistula allows for greater freedom for in-hospital treatment. Patients can now be brain resulting in cerebral edema. Symptoms: 
1 0f activity for the patient. Infections are dialyzed successfully for a longer period of headache, nausea and vomiting, confusion, 
, reduced because there is no external time ... But the problems associated with possible hallucinations and convulsions. 
I connection, and accidental bleeding is not a uremia and dialysis itself are such that . acute hypertension - This is thought to 
problem. Regular venipunctures for the transplantation is still the objective of patients be caused by anxiety related to dialysis, and 
I initiation of dialysis, however, can be difficult involved in long-term dlaJysis programs. Some the disequilibrium syndrome. 
I for the patient. of the problems associated with dialysis are: . hypotension - Thought to be caused by 

1. "Weighing in" on admission 1 
to the dialysis unit. 

2 Admission to the dialysis unit Includes 
taking the patient's blood 
pressure and temperature. 

3. Teaching the patient to prepare 
the dialyser for dialysis. 

4. Drawing up heparin to prime needles. 

5. Patient learning to do her own 
venipunctures for initiation of dialysis. 


.. '-' 
..- Æ




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j '.. 
_1 t 
C' r.- .
r . 
7. \. , 
ß r--
.... . 





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The Canedlan N..... March 1977 

... .


rapid removal of fluid during dialysis 
. nausea and vomiting - Causes include 
disequilibrium syndrome, hypertension, 
hypotension, anxiety, possible peptic ulcer, 
inadequate dialysis with retention of uremic 
. headache - Due to anxiety, 
hypertension, and the disequilibrium 
. bleeding - Due to heparinization during 
. fever - Usually a result of infection 
. muscle cramps - Thought to be due to 
rapid sodium and water removal 
. arrythmias -Due to hypotension, 
electrolyte disturbance 
. chest pain - Hypotension and 
arrythmias may lead to angina 
. restlessness - Due to anxiety, 
disequilibrium syndrome 
. depression and hostility - Related to 
the necessity for the regular stress of dialysis 
. shunt problems - In hemodialyzed 
patients, shunt problems are common, and 
may include clotting and infection. Loss of 
shunt sites through infection can threaten the 
continuity of therapy for hemodialyzed 


using the left arm fistula. By this time, Stephen 
was very anxious, discouraged, and 
depressed. Venipunctures for dialysis were 
difficult because the fistula vessels remained 
tortuous. Stephen cried every time the needles 
were inserted and was increasingly 
apprehensive with each dialysis run. His 
anxiety over his illness seemed to find a focus 
on the needles he received each time. 
Emotionally, he tolerated dialysis very poorly. 
In the meantime, Stephen's family had 
been tissue-typed for p05sible kidney 
donation. His brothers and sisters were all 
willing to donate a kidney, but several were 
younger than Stephen, and therefore 
unsuitable as donors. 
An older sister, married with two children, 
was a fair match with Stephen, and shê was 
very willing to donate a kidney. It was decided 
after further tests, that Stephen would receive 
a kidney transplant in July, with his older sister 
as donor. 
After almost a year and a half on dialysis, 
Stephen was excited about the transplant and 
looking forward to the independence that it 
offered. He began to say goodbye to the renal 
nurses who had cared for him during that time. 

renal nurse knows Stephen, knows that his 
goals, his lifestyle, his "self", have undergone I 
a stressful change, and she is able to respond I 
to him in a helpful, supportive way. Guided by 
Stephen's acceptance of treatment and his 
level of knowledge, she is able to teach him 
about his illness and understand his 
receptiveness or lack of it. She shares his 
hope for a successful transplant and helps him 
to prepare himself for transplantation. I 
Not so the nurse on another floor of the 
hospital. If Stephen is admitted to her ward, 
and there is a good chance that he may be, she 
is confronted by a "renal patient," lethargic, I 
sometimes demanding, and "childish." She 
may be unfamiliar with what end-stage renal 
failure means, and with his treatment regime. I' 
she is out of touch with what all this means to 
Stephen, she may interpret his behavior as 
plain difficult and respond with feelings of 
inadequacy and resentment. It becomes easy 
then to stereotype Stephen as "just another 
renal patient." 
Understanding the dynamics of chronic 
renal failure, and understanding Stephen, may 
take time. But supporting Stephen depends on 
the time you take to understand. ... 

. Awaiting Transplantation 
Stephen's eagerness for a transplant was 
not a wild hope for a cure that would end all his 
problems. The difficulties he had because of 
uremia and dialysis, and the restrictions 
necessarily imposed on his lifestyle naturally 
inspired his interest in any alternatives. But as 
with most patients on a dialysis/transplant . Implications for Nurses 
program, he had been fully aware of The nurse's role as teacher and supporter 
transplantation as a realistic altemative since is an important key in helping the patient in 
the beginning of his treatment. The nurses chronic renal failure adapt to his illness and its 
who saw him weekly, a nurse-teacher on the treatment, and to the disappointments that he 
dialysis program, a home dialysis instructor, may have to face... Nurses who work with 
medical staff, and social workers had begun to patients in renal failure on a daily basis are well 
teach him at an early date about the possibility aware of the stresses on the patient as an 
of a kidney transplant to replace his current individual; the stress of chronic illness, the 
treatment. threat and actualization of complications, and 
By August of 1974, Stephen was admitted the problems posed by medical treatment. Bibliography 
for the creation of an arteriovenous fistula in More important perhaps, they get to know the 1 Gutch, C. F. Review of hemodialysis for 
his left arm, because he had had so many patient himself; in helping him learn to cope nurses and dialysis personnel, by no and Martha H. 
problems with cannula infections in the left leg with his condition, they become involved in a Stoner. 2ed. St. louis, Mosby, 1975. 
site. At this time his blood results indicated: relationship with the patient and his family, and 2 Hansen, Ginny L. ed. Caring for patients with 
Hgb 8.1 gm; phosphate 5.2 mg%, calcium 9.1 see him as a person of many dimensions in the chronic renal disease; a reference guide fornurses. 
mg %, creatinine 9.6 mg %, BUN 57 mg %. context of his life. Rochester, N.Y., Rochester Regional Medical I 
T k S Program and University of Rochester, 1972. 
By October, another left leg shunt a e tephen as an example. To the 3 Harrington, Joan Delong. Patient care in 
infection had to be treated with antibiotics, but nurse in the renal unit, his tears and renal failure, by... and Etta Rae Brener. Toronto, r 
the treatment was unsuccessful. As the fistula depression can be seen as his response to his Saunders, 1973. ' 
in his left arm was small and tortuous, another whole life situation, not as a childish reaction to 4 O'Neill, Mary ed. Symposium on care of the 
shunt was inserted in his right leg. After this needles. His illness has brought about a patient with renal disease. Nurs. Clin. North Am. I 
procedure, he returned home and continued change in his choice of careers, in his financial 10:3:411-412, Sep. 1975. t 
dialysis there. Psychotherapy had since been status, in his family relationships. From 5 Schlotter, lowanna ed. Nursing and the , 
initiated for sexual problems. Further shunt independence and health he has become nep
problems led to Stephen's readmission in dependent and feels constantly ill; he is and 
ss,!es. Flushing, N.Y., Medical Examination 
June of 1975, and he was dialyzed in-hospital sexually impotent; and he is frightened. The Pubhshlng Co., 1973. C 
...................................................... ..................................................

Acknowledgment: The author would like to 
thank the staff at the University of Alberta 
Hospital in Edmonton for their co-operation 
and assistance in the research and writing 
involved in preparation of this article. Their 
help during my visit, particularly the help of 
Anita Yanitski, clinical instructor in the Renal 
Unit, is greatly appreciated. - L.F. 

I :;Iinical Wordsearch no. 

'-his is another in a continUIng series of clinical 
Ivordsearch puzzles relating to different areas of 
\,ursin g , by Mary Elizabeth Bawden (R.N., 
.Sc.N.) who presently works as Team Leader 
I J the Rheumatic Diseases Unit, University 
; -Iospital, London, Ontario. 

Solve the clues. The bracketed number 
indicates the number of letters in the word or 
words in the answer. Then find the words in the 
accompanying puzzle. The words are in aff 
directions - verticaffy, horizontally, diagonaffy, 
and backwards Circle the letters of each word 

found. The letters are often used more than once 
so do not obliterate them. Look for the longest 
words first. When you find all the words, the 
letters remaining unscramble to form a hidden 
answer. This month's hidden answer has fIVe 
words. (Answers page 30). 


o H E DEL U BUT T B H E U 0 L I 

1 A variety of nephritis characterized by 
inflammation of the capillary loops in the 
glomeruli of the kidney. (18) 
2 Distention of renal pelvis and calices with 
urine. (14) 
3 Rubber or silastic tubing; may be straight 
or indwelling. (8) 
4 Amber colored liquid excreted by 12. (5) 
5 Function of the kidney. (8) 
6 Pertaining to 12. (5) 
7 Often pitting around the ankles. (6) 
8 The presence of protein in the urine. (11) 
9 A method sometimes used in patients in 
kidney failure to remove from the blood 
elements that are normally excreted in the 
, urine. (8) 
" 10 A method of dialysis which IS not 
extracorporeal. (10) 
111 Basic unit of function of the kidney. (7) 
12 Sometimes borrowed, hopefully not bl ue. (6) 
13 As it descends and ascends it forms a 
loop. (6) 
14 Acts as a cistern (7) 
15 An advanced form of mathematics, may 
be renal. (8) , 

16 Gland subject to hypertrophy in older 
men. (8) 
17 What short-wave radios and bladder 
infections have in common. (9) 
18 Not basic to anything. (4) 
19 Inflammation of 14. (8) 
20 Has a burning quality when 
accompanying 19. (4) 
21 Not full. (5) 
22 To avoid infection, urinary catheter 
drainage systems should be maintained 
this way. (6) 
23 You've got it with a diastolic> 100 mm 
Hg. (12) 
24 Heavy on a dieter's mind. (6) 
25 Presence of pus in the urine. (6) 
26 Presence of nitrogen-containing 
compounds in the blood. (8) 
27 Element deleted from or reduced in diets 
of many with renal disease. (6) 
28 Useful for those who would rather switch 
than fight. (10) 
29 The downward displacement of a kidney. 
30 Mineral found in milk and sardines. (7) 

31 The essential or functional elements of 
an organ. (10) 
32 What some bodies do to unwanted 
organs. (6) 
33 Type of medication given to prevent a 32. 
34 Situated above the public arch. (10) 
35 What Lot's wife became. (4) 
36 Null's partner. (4) 
37 Basin formed by the hip bones and lower 
part of the vertebrae. (6) 
38 A growth. (5) 
39 What people in glass houses shouldn't 
throw. (6) 
40 Type of acid which precipitates to form 
crystals. (4) 
41 Carries urine from kidney to bladder. (6) 
42 Blood Urea Nitrogen. (3) 
43 The lower it is, the stronger the acid. (2) 
44 Intravenous Pyelogram. (3) 
45 Important ingredient in Maalox. (2) 
46 A drug which may be used in treating T.B. 
of the kidney. (3) 
47 Liquid. (5) 




The Canadian N...88 March 1877 


Principles I: 
of Pri mary I 

The Role 
of the 
Head Nurse 

Diane Bartels, VIvian Good, Susan Lampe 


Primary nursing as a philosophical and organizational 
approach to hospital nursing, is a pattern of care de- 
veloped in the mid-Western United States almost ten 
years ago. Its chief characteristic is a one-to-one rela- 
tionship between the patient and the nurse who provi- 
des his care. Innovator Marie Manthey has described 
primary nursing as "essentially a return to the concept 
of 'my' nurse and 'my' patient." 
Supporters of the system point out that it offers a 
means of providing the personalized, comprehensive 
or total care that both patients and providers of care 
often complain is missing in today's health care sys- 
tem. From the point of view of the nurse, the key to 
primary nursing is her accountability for the total care 
of all patients assigned to her, on a day-to-day basis, 
from admission to discharge. Each nurse is a "primary 
nurse" when she is responsible for the care of a pa- 
tient throughout his stay in hospital; she is an "asso- 
ciate nurse" whenever she cares for a patient whose 
nurse is off-duty. 
Primary nursing was first introduced in 1968 on a 
trial basis on a 24-bed medical unit at the 829-bed 

University of Minnesota Hospitals in Minneapolis, 
Minn. Since then, hospitals in many states of the U.S., 
Including California, Michigan, Wisconsin, Illinois, 
Pennsylvania, North and South Dakota, Iowa, and 
Washington, have introduced primary care programs. 
Last year, the American Journal of Nursing (May, 
1976), while conceding that primary nursing is "still In 
the experimental stage" described the system as 
"highly rewarding for both patients and nurses" alid 
predicted that it was on its way to becoming widely 
accepted on a national basis. 
In Canada, application of the principles of primary 
nursing has been confined largely to the one-to-one 
relationship of public/community health nurses with 
individual patients in their homes and to psychiatric 
and intensive care settings in some hospitals. 
Recently, however, nurses working in other areas 
of general hospitals have indicated a growing interest 
in learning more about the primary nursing concept 
and how it can affect their relationship with their pa- 
tients, with other health professionals and with their 
fellow nurses. 

in Primary 

1. 24-hour decision-making for 
several patients by one nurse; 
2. nursing assignments based on 
matching patient needs and nursing skills; 
3. nursing care planner Is the care-giver; 

Primary nursing brings about changing 
roles, responsibilities, and communication 
patterns for all members of the health care 
team. The head nurse, as she Introduces 
new staff to primary nursing and Its 
day-to-c/ay applications, Is In an Ideel 
position to generate enthusiasm for the 
goals of the concept. In attempting to 
Implement this new care pattern, she must 
continually promote the philosophy behind 
I It by her support and recognition of Its 
prlnclples.ln the long run, It Is the positive 
attitude and high motivation of the head 
nurse that will determine the success or 
failure of the program wherever It Is 

One nurse, one patient - planning care 
together ... Primary Nursing, as a 
philosophical and organizational approach to 
hospital nursing, has been defined by 
Manthey' as encompassing five principles: 
. 24-hour decision-making for several 
patients by one nurse; 
. nursing assignments based on matching 
patient needs and nursing skills; 
. nursing care planner is the care-giver; 
. direct care-giver to care-giver 
. head nurse in a crucial role as leader, 
clinician, consultant, evaluator, staff developer 
and teacher. 
Of these, it is the last principle, the role of 
a head nurse in primary nursing, that the 
authors examine in the light of their own 
expenence. Their observations reflect 
traditional aspects of this position, as well as 
some aspects that are unique in a primary 
nursing setting. 
If the head nurse is to successfully 
assume the role of leader, clinician, 
consultant, evaJuator, staff developer and 
teacher, two conditions must be met within the 
organizational set-up. First the nursing station 
should be of a reasonable size with the 
capacity to handle 25-35 patients. Second, a 
strong managerial roleforthe station secretary 
(or ward clerk) should be developed. 
Why are these factors vital? Size of 
station takes on considerable importance 
when the reorganization of station functions is 
realized. With dissolution of the team leader 
position, the head nurse becomes the sole 
quality control agent of that station. A small 
station, with fewer patients and personnel to 
coordinate. affords the head nurse more time 
for emphasis in the clinical area. 
This clinical emphasis is strengthened 
further by the second prerequisite. a strong 
managerial role for the station secretary. The 
head nurse will never be in a position to focus 

4. direct care-giver to care-giver 
5. head nurse In a crucial role as 
leader, clinician, consultant, 
evaluator, staff developer and teacher. 

on patient care if she is absorbed in activities 
centered at the main desk. This implies that 
the head nurse must want to relinquish many 
of the managerial functions and that she must 
have someone who can responsibly assume 
these for her. In most cases, the activities of 
station secretaries can be extended to include 
areas of communication, ordering of forms and 
supplies, scheduling procedures, traffic 
direction, staffing hours, order transcription, 
and possibly reception of verbal and telephone 
When these criteria are met, at least the 
supportive envi ronment for a clinically oriented 
head nurse role is established. 
. The head nurse as leader 
In any nursing organization the head 
nurse role, broadly defined, is that of 
leadership. The main focus of that leadership 
in primary nursing is quality patient care. To 
accomplish that goal, the head nurse's 
emphasis must be more clinically-oriented and 
less managerial than traditionally 
demonstrated in other systems. 
If the goal is quality patient care, then the 
head nurse must be out in the area where this 
care is given. Both as a role model and by 
working closely with the staff and patients, she 
can more effectively determine the standards 
under which patient care will be delivered. Her 
own practice, expectations, and priorities have 
an important influence on staff performance. 
Patient care must be constantly held as first 
priority and staff energies directed towards 
use of the nursing process in pertinent 
observations, assessment of patient needs. 
care planning, intervention, and evaluation. It 
is our experience that individuals will most 
often excel in those areas consistent with the 
indicated expectations and rewards. 
In addition to the setting of standards, 
another important aspect of the head nurse 
leadership role is her style of leadership. In 
primary nursing, her leadership style must 
facilitate independent and interdependent 
decision-making. This is achieved through the 
process of decentralization whereby the head 
nurse delegates authority, responsibility, and 
accountability for the nursing care of a given 
number of patients to the primary nurse. The 
extent of this delegation increases as the 
proven ability of the individual nurse to assume 
responsibility broadens. Theoretically, each 
Registered Nurse and many Licensed 
Practical Nurses (or Registered Nursing 
Assistants) can be developed to the point of 
effectively managing the high degree of 
responsibility required in primary nursing. 
To foster decision-making and 
accountability. the head nurse must be able to 
relinqush tight controls. The pendulum 


between autocratic and democratic leadership 
must swing more in favor of the latter. Basic to 
this democratic style is the ability of the head 
nurse to assume risks. Risk-taking is of vital 
Importance if primary nurses are to know the 
freedom of testing the "rightness or 
wrongness" of their own decisions. Staff must 
know that in some circumstances being wrong 
may be acceptable. It may not be ideal but it is 
human and sometimes the best a person could 
do in a given situation. 
As staff competence in decision-making 
develops, the head nurse's leadership 
emphasis shifts naturally from staff 
development to staff consultation. The 
strength of her consultation role is proportional 
to her excellence in clinical knowledge and 
nursing practice. Thus, her leadership power 
base evolves from personal expertise rather 
than merely ascribed power associated with 
the position. 
A vital adjunct to the role of consultant, is 
the ability of the head nurse to trust and be 
trusted. The staff must not only feel that the 
head nurse is competent but approachable, 
open and equitable. When the head nurse and 
staff can work together in an atmosphere of 
open communication and mutual respect, the 
potential for excellent patient care and 
professional development is unlimited. 
Finally, the head nurse must demonstrate 
leadership in understanding of and 
commitment to the concept of primary nursing. 
She is responsible for assisting staff in the 
implementation process and she is vital to the 
maintenance of the principles. The transition 
process from team systems ortask orientation 
is long and difficult. An adjustment period of 
twelve to eighteen months should be 
. The head nurse as evaluator 
In her role as evaluator, the head nurse 
must deal with assessment of patient needs 
and assessment of a particular nurse's ability 
to meet those needs. Ideally, she will match 
the two appropriately. 
In evaluating a patient s needs or 
identifying his problems, the head nurse 
considers the presenting complaint, as well as 
co-existing conditions. Data is also extracted 
as available and appropriate from the 
. past records 
. the nursing admission history 
. the physician's history and physical exam 
. referral notes 
. personal encounter with the patient or 
From this information, she attempts to 
predict the course of hospitalization, focusing 
on long-range plans rather than one day's 

The Role 
of the 
Head Nurse 

The C8""dI8n NU'88 March 1917 

expectations. Her initial assessment is not 
infallible and may requi re readjusting at a later 
Evaluation of the nursing staff is an 
ongoing process. The organizational pattern 
of primary nursing provides many tools to 
fadlitate staff evaluation. A single staff nurse is 
responsible and accountable for total ongoing 
care of spedfied patients. Therefore, the 
nursing admission history, daily progress 
notes, written care plan and observation ofthat 
plan executed provide pertinent information 
about the primary nurse. They reflect her 
interviewing skills, knowledge and 
understanding of her patient's problems, her 
ability to monitor those problems, to provide 
relevant care, and to evaluate her own 
Since the head nurse is physically present 
in the patient care area instead of at the desk, 
she is able to observe the quality of nursing 
care being given. She may also give bedside 
care to a patient whose primary nurse is off 
duty. This provides an ideal opportunity to 
evaluate the patient's condition and the 
completeness or effectiveness of the nursing 
care plan recorded in the patient record and/or 
Many aspects, then, of the primary 
nurse's performance are readily assessed 
with concrete examples taken from her clinical 
practice. These examples become valuable 
tools in preparing meaningful written 
evaluations for periodic progress discussion. 
The evaluation of patient needs and of 
nurse performance are then appropriately 
combined in the formulation of the 
nurse-patient assignment by the head nurse. 
She assigns each patient to a nurse within 24 
to 48 hours of the patient's admission. This is a 
complex decision. As previously stated, the 
head nurse uses all available data to evaluate 
the patient's psycho-sodal and physical 
needs. In addition, she must consider the 
acuity level of the patient, his education needs 
and any personal preferences. This data is 
then considered in reviewing the staff nurses 
who might be available for assignment. In 
selecting the best nurse, the foremost 
considerations are the interpersonal and 
technical skills of the individual and the scope 
of practice permitted by licensure laws as 
compared with what is needed by the patient. 
Other factors include the current case load of 
the nurse and any special interests the nurse 
may have. Are there nurses, for example, who 
particularly enjoy working with surgical versus 
medical patients, with newly diagnosed 
diabetic patients, or with geriatric patients? 
Another influence is the nurse's work 
schedule. Usually a nurse is not assigned new 
patients during the week prior to beginning the 

night shift. At times a nurse may ask to care for 
a particular patient. This can be appropriate 
provided the head nurse agrees that the 
nurse's selection is compatible with her 
abilities and the needs of the patient. Also, a 
primary nurse is encouraged to re-establish 
her relationship with a patient to whom she 
was assigned during a previous 
Educational needs of a nurse might be yet 
another consideration influencing assignment 
However, in this case the head nurse is 
responsible for helping the nurse to learn and 
practice the necessary skills. 
Lastly, geographical location of each 
patient on the station plays a part but should 
not be a major criterion. If geography is 
permitted to strongly influence assignment, it 
defeats the principle of nursing assignments 
based on skills needed by the patients. 

. Teacher, staff developer, and 
facilitato r 
Using the evaluation process described, 
the head nurse is not only able to assess which 
nurse is most appropriate for a particular 
patient but she is also able to determine 
educational needs of the nursing staff of the 
Areas most frequently identified include 
the following: 
. interviewing and assessment skills 
. technical skills especially with the new 
. disease and its implications for patient 
. complex psycho-social problems 
. teaching techniques 
. care planning 
. communication skills in reference to 
interaction with other health disciplines or 
. change process 
. problem-solving and dedsion-making. 
Without doubt the need for skill in 
interviewing and data collection influences the 
entire nursing process. Poor interviewing 
techniques and insufficient data collection can 
only result in deficient planning. Primary 
nurses frequently express difficulty in knowing 
what kinds of questions to ask of patients or 
how to approach "sensitive" topics. The head 
nurse is responsible for finding an effective 
method to develop these skills. 
The head nurse can also be instrumental 
in developing technical skills of the new 
graduate. One way of doing this is to assign 
the nurse to patients who have needs in the 
area in which the nurse requires practice. The 
head nurse is then obviously required to 
provide the necessary teaching, support, and 
supervision during this procedure. 

The desire for greater understanding of 
disease and disease process rates high 
priority with primary nurses in terms of 
educational needs. Perhaps this is a reflection 
of the "wellness" orientation currently being 
stressed in some nursing schools in the U.S., 
almost to the exclusion of disease process. 
Unfortunately, in a hospital setting, nurses are 
caring primarily for persons whose "wellness" 
has been interrupted by disease. Ifthey are not I 
fully equipped to handle this crisis, their care 
can only be deficient. Many primary nurses 
have recognized this and are now requesting 
classes devoted to disease process. 
The close relationships that often exist 
between primary nurse and patient, make the 
handling of death particularly stressful. 
Dealing with death and dying or with the 
patient who has severe emotional problems 
sometimes necessitates other resources. 
Patient care conferences attended by 
representatives of all health disciplines or by 
special resource persons can be beneficial. 
Discussion of readings and/or experiences 
may also help considerably. Severe problems " 
may require consultation. 
Three important points should not be 
overlooked in reference to patient 
1. The head nurse should encourage primary 
nurses to organize a conference as a means to I 
inform other staff of patient needs or to elidt 
assistance with creative ideas in approaching 
the care of a particular individual. Directing a 
conference develops the primary nurse's 
ability with group process and expands her 
own horizons through various viewpoints 
presented. Conferences also help the primary 
nurse deal with the large responsibility for 
patient care and prevent feelings of being "an 
island unto one's self." 
2. The head nurse should encourage the 
inclusion of patient and/or family in I 
conferences as appropriate. This can assist in 
clarifying and solidifying the nurse-patient I ' 
3. The head nurse should not fail to encouarge i 
utilization of staff talents inherent in the I 
nursing group on the station. This recognizes, 
reinforces, and rewards individual abilities. In 
turn this promotes job satisfaction, high 
morale, and group sharing. I 
Since patient and family teaching is one of i 
the primary roles of the nurse, attention to this I 
area is essential. Didactic classes on the I 
principles of education, experimental I 
situations with teaching, and evaluation of the I 
effectiveness of teaching skills will help 
improve this area. Nurses can also learn 
useful teaching skills through teaching new 
technical skiUs or information to their peers. 
Continuous support by the head nurse will 

I encourage growing proficiency in patient 
I teaching. 
Care planning requires some assistance. 
Initially, primary nurses may be hesitant to 
commit themselves in writing. They need 
guidelines and positive reinforcement from the 
head nurse. Review of written care plans by 
the head nurse is essential to indicate to the 
staff this expectation of Derformance. 
If inappropriate deviations from the care 
plan or lack of adherence to the primary 
nurse's care plan by other nurses occur, it may 
be necessary for the head nurse to intervene. 
, Reiteration of the importance of following a 
I care plan reinforces the fact that nursing 
I directives are as important as physician orders 
to planned care and continuity. Sometimes, 
too, the primary nurse needs a reminder to 
include the patient in discussion about his plan 
of care during his hospitalization. 
Communication channels in primary 
nursing are radically different from traditional 
hospital systems: the head nurse is no longer 
the single information source and primary 
decision-maker on the station. Instead, she 
promotes direct care-giver to care-giver 
communication by supporting the primary 
nurse as the nursing person responsible for 
communication of verbal and/or written data 
concerning her patients to physicians and any 
other health disciplines involved in the care of 
her patients. In addition, change of shift 
reports are organized so that the nurse who 
has been responsible for patient care reports 
directly to the nurse who will assume these 
responsibilities on the next shift. 
If the transition from a traditional system 
of statio;; organization to primary nursing is to 
succeed, it is essential that the head nurse 
adequately prepare personnel forthe change. 
Her approach to this task depends upon her 
own approach to change. Again, her 
openness, willingness to experiment, and 
sense of adventure will have a direct influence 
I on the staff. As in any other aspect of station 
activities. change necessitates a positive 
support system if it is to succeed. Some 
notable factors the head nurse should 
consider in promoting changes are: sensitivity 
to where the staff is mentally and emotionally 
in terms of change; group involvement in 
decision-making about the innovation with 
recognition of contributions made by staff 
members: good sense of timing in terms of 
proceeding with the change process; close 
communications so that a clear understanding 
of the change is commonly held; close 
follow-up so that feelings and problems are 
dealt with before they become 
disproportionate; finally, much positive 
reinforcement and feedback. 
The primary nurse must be competent in 










\ 1 




the areas of problem-solving and 
decision-making. The head nurse facilitates 
these skills as a consultant and validator by 
acting in a way which will maintain open 
communication, support and teach the 
decision-making process to less profiaent 
staff, recognize and encourage staff who 
make good decisions, and disseminate the 
clinical knowledge which the staff nurse 
requires to make her decisions. 
When the head nurse recognizes that 
good judgment is being utilized, immediate 
recognition of that fact provides feedback and 
reinforcement essential to staff satisfaction 
and performance. As more experience is 
gained and self confidence grows, the need for 
frequent validation will lessen. The staff nurse 
will gain more confidence in her own abilities 
and the head nurse will learn to trust the 
individual's judgments. Responsibility allowed 
will then be appropriately proportional to 
proven ability. At this point interactions 
between staff nurse and head nurse become 
informative sessions. The staff nurse will 
describe proposed plans or actions already 
executed and their outcomes rather than 
asking permission to act. In this context the 
head nurse maintains final responsibility for 
the station activities while fulfilling her role as 
quality control agent. 



, '" 
. u 


. Rewards 
In primary nursing, the rewards for the 
head nurse come from her clinical orientation: 
. Because she is relieved of many 
administrative tasks she has the opportunity to 
again become a bedside nurse herself. She is 
able to becom
 involved with the patients as 
people and not just statistics through bedside 
rounds with the primary nurse, through patient 
interviews, and through direct teaching and 
participation in bedside care. 
. The greatest reward of primary nursing is 
improved morale and personal growth among 
nurses who work in an atmosphere which 
promotes expression of the full breadth and 
depth of their professional skills. Each staff 
nurse can see directly the result of her 
individual efforts. This direct feedback fosters 
enthusiasm and concem to increase technical 
skills and clinical knowledge. Individual nurses 
are recognized for an area of expertise and 
invited to teach the other staff. More creative 
problem-solving is encouraged when one 
nurse is responsible for the comprehensive 
care of specified patients. 
. Continuity of patient assignments 
contributes to increased personal 
commitment. The patient can identify "my 
nurse" and the nurse can identify "my patient." 
The primary nurse assignments concern 


The Cenedlen March 1977 

people and not tasks. Family members are 
especially appreciative to have one particular 
nurse to consult. 
. Physicians' comments are uniformly 
favorable when they discover that the 
responsibility for the care of their patient is 
assumed by one individual who is thoroughly 
familiar with the medical problems involved 
and is qualified for and committed to providing 
optimum nursing care. 
The head nurse who watches her staff 
develop professional skill and competence 
has the right to be proud. Primary nursing 
provides the organizational system which 
makes quality, patient-centered care a 
possibility. Head nurse leadership makes it a 
reality. ... 

Vivian Good. Diane Bartels and Susan 
Lampehave each held head nurse positions 
on Primary Nursing Units. Diane Bartels was 
the first head nurse on the pilot station at 
University Hospitals, Minneapolis, Minnesota 
where Primary Nursing originated. She was 
succeeded by Vivian Good. Both worked with 
innovator Marie Manthey in the development 
of this new approach to patient care which 
has since gained widespread 
acknowledgment. Since then, Susan Lampe 
implemented Primary Nursing on her medica/ 
unit at United Hospitals in St. Paul. 
Each of the authors through their 
experience with Primary Nursing identified 
the need for a clearer definition of the Head 
Nurse role since leadership was observed 
over the years to be a key factor in the success 
of this innovation. Hence their philosophies, 
experiences, and enthusiasm have been 
combined to produce this article. 
Vivian Good is a native of Winnipeg, 
Manitoba and a graduate of St. Boniface 
School of Nursing in St. Boniface. She worked 
at the Manitoba Rehabilitation Centre before 
moving to Minneapolis to become a staff 
nurse in Medica/IntensIve Care at University 
Hospitals, University of Minnesota and a year 
later became head nurse on the Primary 
Nursing Unit. Since that time she has 
conducted numerous workshops on the 
topic and has been involved in private 
consultation in U.S. hospitals and now in 
Canada. Currently, she resides in Detroit 
Lakes, Minnesota where she works as an 
Adult and Geriatric Nurse Practitioner for 
Multi-County Public Health Nursing. She also 
holds a part-time position with the University 
of Minnesota Community Services 
Department and is in her last year of the 
Bachelor of Sciences in Health Services 
program at Moorhead State University. 

":: .. 


0 '1 
-91 '- 


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. ","y. 



Diane Bartels, R.N., B.S., M.A., is a 
graduate of St. Mary's School of Nursing in 
Minneapolis and received her Bachelor's 
Degree in Nursing from Marycrest College in 
Davenport, Iowa and her Master of Arts in 
Psychosocial Nursing from the University of 
Washington. She is presently associate 
director of nursing at Methodist Hospital in 
Susan Lampe R.N., is a graduate of 
Comell University - New York Hospital School 
of Nursing, and is presently a graduate 
student at the University of Minnesota School 
of Nursing. 
1 Manthey, Maria. "Primary Nursing is Aliva and 
Wall intha Hospital," Amer. J. Nurs. 73:1, January, 
A raading list is also availabla from tha Canadian 
Nursas Association Library 


Clinical Wordsearch 
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The leukemic child looks into the mirror provided by his peers who are sick like himself. The image of his 
future self that he sees reflected there provides him with the knowledge and understanding that he needs 
to cope with a life-threatening illness. 






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leukemic child deal with so many questions? 
One way is by reducing them to a manageable 
level through the use of "mirroring" - a 
process whereby the child. by identifying with 
and watching others. sick like himself, is able 
to see his future in them. For the child. it is like 
looking into a mirror and seeing a reflection of 
his future self. 
While working as a clinical nurse 
specialist with leukemic children on an in- and 
out-patient basis throughout the course of their 
illness. I had the opportunity of observing their 
behavior. What follows is an account of how 
some of these children between the ages of 
nine and eighteen years used mirroring as one 







'\- . 

,D"\ 'I"
:if< '. :It. 

'",.:;-. .. 

June Kikuchi 

Illness, and especially hospitalization, 
subjects a child to a host of uncertainties. Will 
his mother return to visit? Will he get another 
needle? Will he die? A child with a 
life-threatening illness. such as leukemia, 
faces these uncertainties repeatedly. In 
addition, he is subject to numerous other 
uncertainties such as, "Will my hair fall out 
when I take this medicine? What will I look like 
bald? Willi be able to get a wig to suit me? Will 
the treé.ttment work this time? Will anyone 
marry me now? How willi know when I'm going 
to die? Will my parents be able to stay with me, 
if I'm going to die?" Too many uncertainties 
can be intolerable. How then does the 

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way of facing the uncertainties that beset 
them. All of them had ample opportunity to see 
other children with leukemia in the ward (which 
usually contained at least six children with 
leukemia at anyone time) or in the hematology 
out-patient clinic. Some had been told that 
they had leukemia and perhaps its prognosis; 
others had been told that they had anemia or a 
blood disorder, etc. No matter what they had 
been told, they all seemed to get information 
from the child who looked like them and 
received similar treatment. He was the best 
teacher. The children used mirroring primarily 
to deal with uncertainties such as body 
mutilation and death, described elsewhere. 



Wi Uncertainties surrounding body 
The leukemic child reduces his 
uncertainty about forms of body mutilation 
such as an intravenous infusion to a 
manageable level by watching other children. 
After he sees that others receiving intravenous 
infusion can move about, do things for 
themselves and are not badly mutilated, he is 
For a child to be told his hair will fall out 
because of chemo- or radiotherapy is 
frightening. How will his hair fall out? What will 
he do without hair? How will he look? Will his 
hair really grow in again? To see what will 
C actually happen to his body and how it can be 
,) fixed is reassuring. Truth is less traumatic than 
I all kinds of terrible imaginings. Forthis reason, 
he seems to change his uncertainties to 
certainties by observing other children who 
have lost their hair and now wear attractive 
I wigs. When he is informed that he, too, will 
I lose his hair, he is upset and wants to be sure 
he can get a wig which will look like his own 
hair. He is further reassured by seeing children 
whose hair has already started to grow in 
Loss of hair is of concern to the 
adolescent boy as it signifies loss of 
masculinity to him. To the adolescent girl, it 
represents loss of feminity. Another concern of 
the adolescent girl centers on how her disease 
will affect her ability to have a baby. She also 
wonders if the baby will be mutilated by her 
leukemic drugs. 
s she approached the third year of her initial 
remission, Lynn, an amiable 
eighteen-year-old girl, asked the doctor If she 
would ever be able to have a baby. She wanted 
to know if the baby would be deformed by her 
drugs. The ensuing intellectual discussion did 
not seem to reassure Lynn. The doctor then 
talked with her about Kathy, a twenty-year-old 
girl who had had leukemia for five years. Lynn 
knew her and had identified with her in the past. 
When the doctor told her about Kathy's plan to 
have a baby when she came off her drugs in a 
half year, Lynn looked relieved. By identifYing 
with Kathy, Lynn was able to change her 
uncertainty about her ability to have a baby to a 
certainty. If Kathy could have a baby, then she 
could also have one. 

In this way, by watching what happens to 
others with a similar illness, the leukemic child 
gains information about how his body will be 
affected by the disease and treatment. 

w; Uncertainties surrounding death 
The leukemic children, especially those 
who were not told they had a life-threatening 
illness, came to suspect it from the necessity 
. for frequent visits to the doctor, daily 
medications, various procedures. blood 
transfusions, and repeated hospitalizations. 2 
They changed this uncertainty about the 
nature of their illness to a certainty by getting to 
know at least one other child who was sick like 
themselves. Later, when he died, their 

The Canadian Nurse March 1977 

suspicion was confirmed. The children kept 
track of one another by writing or visiting their 
sick friends when they were hospitalized; they 
also asked about one another. 
Judy, a bright, alert, nine-year-old girl was told 
she had anemia. She had two roommates, 
Sherry and David, both nearing the terminal 
phase of the leukemic process. Soon after 
Judy was discharged from the hospital she 
began to ask her mother how Sherry and David 
were. She knew her mother talked with their 
mothers. When told about David's death Judy 
was upset and asked, "What" s gOing to happen 
to Sherry? David and Sherry have the same 
thing!"' Each time she came to clinic, Judy 
would ask me how Sherry was. If Sherry was in 
the hospital, Judy visited her. When Sherry 
died, Judy's mother did not want her daughter 
to know, because David's death had upset her 
so. We later decided it would be better to tell the 
truth so as not to lose Judy's trust. Upon being 
told. Judy said that she would have kept asking 
as she knew something was going to happen to 
Sherry She then cned, .. I'm scared I'm going 
to die too. Sherry and I have the same thing." 
When asked why she thought so, she 
explained, "We take the same medicines We 
both lost our hair." She had learned by 
mirroring, not by being told that she had a fatal 
Tim a quiet sixteen-year-old boy, rarely asked 
questions about his disease once the doctor 
had discussed it frankly with him. But when a 
leukemic child Tim knew died, he was anxious 
to talk about it; he wanted to know why the child 
had died. He also wanted to know if having 
leukemia would shorten his life span and he 
asked me what he could do to help himself. 

Thus, by keeping track of one another, 
these children are able to confirm their 
suspicion that they have a life-threatening 
illness. If Nagy's belieP is true that at nine 
years of age a child achieves a realistic 
conception of death as a permanent biological 
process. then why would they want to confirm 
what seems to be a frightening suspicion? 
Probably because it is easier to face certainty 
than uncertainty. A known phenomenon can 
be grappled and dealt with while an unknown 
phenomenon cannot. 
On the other hand, by keeping track of 
one another, the child can also confirm the 
suspicion that, although he may die, he can 
also live for awhile too. For example, the 
adolescent girl who has dreamt of marriage 
becomes especially worried about whether 
she will live long enough to get married. 
Soon after Sandi, an inquisitive 
sixteen-year-old girl was found to have 
leukemia, she became friendly with Tom, 
another leukemic adolescent, who later died 
after being ill for four years. Sandi knew she 
had leukemia. After Tom's death, she was 
depressed and, no matter what she was told. 
talked about having only four years left. At the 
clinic, she met an attractive twenty-year-old girl 

who had had leukemia for five years and had 
just been married. Sandi shed her depression. 
She could identify with another girl who act ually 
had lived for more than four years- someone 
who had married. Sandi began to be interested 
once again in dating, in getting married and in 
having babies. 

However, sooner or later as the leukemic 
child becomes increasingly ill and the threat of 
death becomes more real, he wants to know 
when and how he will die and what will happen 
to him. Again he learns the answers from other 
children with a similar illness. 
Upon his second hospital admission, 
Danny, a fifteen-year-old adolescent who had 
been told he had a blood disorder, asked. 
"Whars happened to Ralph, the boy who was 
in the room with me before? Did he go home? 
Why did his parents sleep here?" When he was 
told that Ralph and died, Danny said, "I 
wondered if he had made it. He didnllook so 
good. Is that why his parents slept here?" 
Danny then went on to talk about the possibility 
of freezing bodies until cures were found. He 
said calmly, "I know I'mmcurable." A year later 
when his condition worsened and his parents 
stayed with him through the night at the 
hospital, Danny accepted without question 
what this meant. 

Sometimes the child observes when and 
which child is moved into a private room and 
keeps close watch. On passing the room, he 
may glance quickly inside to see how the child 
looks and what is happening. Once the door 
remains closed for privacy and he is no longer 
able to see into the room, he watches who 
goes in and out and studies their faces. 
Occasionally he plants himself in the hall 
across from the room and keeps a vigil. 
Trudy, a curious eleven-year-old girl who had 
expenenced several relapses. was told she 
had a blood disorder. One day while we played 
a card game, a child on the ward died. In the 
middle of our game, I was called away. When I 
returned. Trudy was not In her room. A few 
minutes later she returned. She had gone, she 
said, to see if I had left the ward. When I 
mentioned that I had noticed that the door to 
Room 310 was open again, Trudy quickly and 
eagerly exclaimed, "Yeah, I saw that too! Did 
someone die in there?" When I said yes, Trudy 
said, "I thought so. I've seen people come out 
of the room crying." The card game was 
forgotten. She talked about how her mother 
had almost died giving birth to her but had seen 
Jesus and not been afraid. Later, Trudy asked 
for the meaning of the words "Blood 
Dyscrasia," an expression she had overheard 
When I answered. "Disease of the blood," 
Trudy emphatically told me, ''I'm not afraid to 
die you know I've been saved." 

Obviously Trudy had come to recognize 
what the opening and closing of a door to a 
private room could mean if people had come 
out crying. When children. like Trudy, have 


made such deductions and have talked about 
their concerns, placing them in a private room 
when they are ill does not seem to come as a 
shock to them. In fact. they expect it and often 
ask for their own room. 
Carol a twelve-year-old girl who knew she 
would soon die from leukemia. asked her 
doctor if she could have a private room when 
she returned to the hospital. She had known 
I several ill leukemic children who had been 
, moved into a private room and died. She had 
, decided she would like to stay at home until that 
, moment she felt "bad enough to come to the 
I hospital. . Hel second request was for her 
mother to sleep in the room with her at the 

Some of the children are more eager than 
others to learn about what happens behind the 
I closed door of a private room. This kind of 
information can only be obtained by asking, 
and the need to learn what might happen to 
them from other children's experiences is so 
great, they usually ask. 

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Where did her mother go? Did her mother stay 
with her?"" We talked about all these things. 

Besides wondenng when and how he will 
die and what will happen to him, the leukemic 
child seems to worry most about whether his 
parents will be allowed to stay with him. The 
most comforting thing he learns from other 
children seems to be that, should he become 
very ill, his parents will sleep in the same room 
with him at the hospital. 

Other children. like Danny have askp.d 
why certain parents remain overnight. Later, 
when they too become terminally ill, they like 
Carol, suddenly ask that their parents be 
allowed to sleep with them. 
Another worry the child has is how his 
death will affect his parents. The adolescent is 
especially concerned about how much worry 
and trouble he is causing them. As he sees his 
parents becoming more exhausted, he worries 
about whether they will survive. What will 
happen to them? What will life be like for them 
without him? Will they miss him? 


, - 

, " " 




Janet a frightened ten-year-old knew she had 
, leukemia and often talked about the time she 
had been so sick she was expected to die. One' 
day, after her afternoon nap, Janet saw Katy's 
I name had been taken off the patient roster. 
She asked, "Where's KatyT When she was 
told that Katy had died, Janet asked, "When did 
she die? Were her parents there? Do the 
nurses know Katy died? They act as if nothing s 
wrong! How does Katy's nurse feel? How did 
her nurse know Katy died? What's going to 
I happen to the teddy bear she always carried? 
Are they going to bury it with her or IS her 
mother going to keep it? How did the nurses get 
Katy out of her room? Where did they take he I? 

Pat, a vivacious thirteen-year-old girl who 
knew she was in her first leukemic remission, 
continued to write and visit the family of a 
leukemic friend who had died. She enjoyed thIS 
contact and commented on how nice it was to 
see that Andy s family still remembered him, 
had pictures of him. talked about him, and 
missed him. She was glad to see how well his 
parents were coping and that they had "not fallen 
to pieces." 

It must be comforting for a child who may 
be concerned about how his family will survive 
without him to see that, if he dies he will be 
missed but that his family will not disintegrate. 

W; Helping the leukemic child to use 
By identifying with children who are ill like 
himself, and by watching what happens to 
them, the leukemic child is able to see his 
future sell in others and thus reduce the 
number of uncertainties facing him to a level 
he can tolerate. Instead of imagining all kinds 
of unreal situations he is able to see for himself 
what might happen. 
. II he loses his hair, he can get an attractive 
wig and his hair will indeed grow in again. 
. He can tell how ill he is by whether he is 
moved to a private room. 
. He knows he will have a nurse and his 
parents stay with him when he becomes very 
Having seen all these things taking place, 
the leukemic child does not at first feel the 
need to ask a lot of questions about himself. 
Instead, he is able to take in everything at an 
emotionally safe distance, that is, one step 
It is important for staff members caring for 
the leukemic child to be aware that mirroring 
does take place and that this is the child's 
indirect way of clarifying his own situation. 
They should realize just how much this 
vicarious experience means to him. But 
mirroring is a process that the child should be 
allowed to carry out on his own. The child 
himself must be allowed to control what he 
wishes to see and what he wishes to deny. 
Staff members can best assist him by being 
available to help him deal with questions and 
concerns aroused by an experience and to 
detect and correct any misconceptions t1e 
might have formed. not by pushing him to see 
what he does not want to see. .... 

Author June Kikuchi's experience includes 
five years as clinical nurse specialist at the 
Hospital for Sick Children in Toronto where 
she worked specifically with leukemic 
children and their parents. In this position she 
initiated care of these children after their 
diagnosIs and then, with staff, continued to 
care for them throughout the course of the" 
June Kikuchi. R.N., B.Sc.N., UN., is now 
in her second year of clinical doctoral studies 
in the Nursing Care of Children program at the 
University of Pittsburgh in Pennsylvania. Her 
studies are funded by the Hospital for Sick 
Children Foundation. A graduate of the 
University of Toronto, S
hool of Nursing she 
received her UN. from the University of 
Pittsburgh School of Nursing after being 
awarded a sCholarshIp from the Canadian 
Nurses' Foundation. 

1 Natterson, J.M. Observations conceming feal 
of death In fatally ill children and their mothers, by... 
and A.G. Knudson, Jr. Psychosom. Med. 22:456, 
2 Green, M. Care of the dying child. Pediatrics 
40:Supp.:495, Sep. 1967. 
3 Nagy, M. The child's theories conceming 
death. J. Genet. Psycho/. 73:3, 1948. 



I ne ,",lInaalan Nurse Marcn 1:tf'/' 



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In the past few decades, nursing has 
functioned in the midst of a world that is 
increasingly geared to specialization. 
Sophisticated technology and burgeoning 
scientific knowledge have succeeded in 
widening the scope of our profession. Yet 
nursing has tended to favor a pattern of 
generalization and has been slow to promote 
specialization, especially in the clinical field, 
among its members. For the most part, the 
development of specialization within the 
profession has emerged with little planning. 
Now, however, the need for specialization 
is at last beginning to be recognized and a 
variety of specialties are emerging. Nurses 
must take their cue from the other professions: 
those of us who want to specialize must 
identify ourselves and be recognized as 
activists - aware of our goals. 1 




The emergence of a specialty follows a 
recognizable pattern: 
1. development of specialist knowledge 
2. application of that knowledge 
3. the choice of those with special interest and 
aptitude to work in that area. 
In nursing, as in medicine. the rapid 
expansion of information makes it increasingly 
difficult to include specialty instruction in basic 
programs. It seems likely that, in the neár 
future, we will be expected to take specialty 
training before we can work in special units. 
The problem is that, as yet, the education 
system is not geared to meet this expectation. 

. The need is known 
In 1925, Goldmark 2 stated that a nurse 
should be able to specialize to meet the 
demands of advances in medicine and 
technology, and in 1932, Weir 3 added that 
opportunities to do this must be made 
available. But nurses have not accepted the 
challenge. In 1967, Murray4 decried the 
apathy within the nursing profession 
concerning the lack of organized specialty 
training for graduate nurses. 
At its 1970-72 biennial meeting. the 
Canadian Nurses Association (CNA) identified 
specialization in nursing as one of its priorities 
for action. Simultaneously, a nation-wide 
survey of Canadian nurses s confirmed the 
need for training in the specialties: the 
concensus favored the use of educational 
institutions rather than hospitals for such 
courses. and stated the need for recognition of 
the special competencies achieved through 
these courses. 


Frankly Speaking is intended as a forúm fòr nurses who want to speak out on 
issues that may influence the future of nursing practice, research, 
administration or education. Guest columnists from time to time will be 
members of the Board of Directors of your national professional association. 
If you have an opinion or concern that you would like to share with your fellow 
nurses, why not write to us. This is your chance to get involved, to participate 
in shaping the destiny of your profession. 

. Is certification the answer? 
Many specialty groups in the United 
States provide specialty training, and 
certification to Canadian nurses because 
equivalent courses are not available in 
Canada. Thus, Canadian nurses working in 
operating rooms, dialysis units, and 
emergency departments, for example, may 
take American courses. But, the certificate 
they earn is not officially recognized in 
In 1958. the American Nurses' 
Association (ANA) set a goal: "To establish 
ways ... to provide formal recognition of 
personal achievement and superior 
performance in nursing." 6 During the next 15 
years, many specialty groups developed, 
offering education and certification to their 
members. The ANA now has seven such 
programs, including geriatrics, psychiatry, 
pediatrics, medicine/surgery, community 
health, and a combined course in obstetricsl 
gynecology and neonatology. 
Originally, the term 'certification' implied 
excellence and an advanced level of training. 
Now, however, with the proliferation of 
specialty groups, it can mean anything from 
minimal standards to the highest level of 
achievement. There has developed a gradual 
recognition of this disparity in the use of the I 
term 'certification', and a growing awareness 
of the conflict between the goals set by the 
ANA and specialty groups. In trying to resolve 
their differences, they are working toward the 
standardization of certification. For example, 
the Nurses' Association of the American 
College of Obstetricians and Gynecologists 
(NAACOG) recently merged with the nurses' 
parent body, to form the 
Nursing Specialty, and the O.A. Nurses' 
Association proposes to form a similar 

. Obstacles to specialization 
Nurses as a profession have been 
described in uncomplimentary terms -terms 
such as apathetic. moribund, and confused.7 
We should be indignant at such a description I 
(moribund we certainly are not, and apathetic 
and confused we hope we aren't) - but when 
this comment was made it provoked little 
response from nurses. However, this 
statement was made from outside the nursing 
profession, and it's an old truth that outsiders 
can sometimes see the problem more clearly. I 
So we must ask: how accurate is this I 
description? In view of the lack of response, 
obviously we are apathetic. We have been 
confused, too, but hopefully, we are beginning 
to sort out the facts. 
What are the obstacles, other than 
apathy, to specialization in nursing? Certainly, I 
there are few incentives. Hospitals have 
assumed almost complete responsibility for 
nurses' clinical graduate training in the 
specialties( i.e., working on specialty wards),1 
but they rarely include instruction in essential 
background knowledge and theory. The nurse 

'10 plans to attend a course must accept that 
obably her colleagues will resent her 
)sence, because of the additional work for 
em. Few hospitals reimburse a nurse for 
king a clinical course; they may approve 
ave of absence - usually unpaid - but 
ovide few bursaries or scholarships. Thus, 
jditional training may cost a nurse thousands 
dollars, for tuition, lost wages, and often, 
)keep in another city. Even then, on her 
,.turn to work, her hard-won training may go 
lrecognized both officially and financially. 
;)me nurses even find that the jobs for which 
ey trained have been filled in their absence. 
So, the great majority of nurses continue 
I provide the best patient care they can, even 
. the expense of their own further education. 

I Today. basic nursing performance 
:andards are available. The next move must 
,e made by the specialty groups which, with 
Ie guidance and support of provincial 
rofessional associations, must define 
niform, high standards for specialty training. 
:epresentatives of the provincial ministries of 
ealth and the nurses' associations should 
ssess the status of nursing specialization, to 
letermine needs and, along with 
presentatives from community colleges and 
niversities, develop specialty courses and 
niform certification standards. The entire 
rocess should be co-ordinated, supported 
nd interpreted by our national association 
:NA) to ensure the same high level of 
ompetence throughout Canada. Such 
ourses should be presented by educational 
'lstitutions in collaboration with their affiliated 
There should be a register of nurses, with 
'nention of specialty certification. as in a 
nedical directory. This could be compiled- 
19ain, as for doctors - from short 
luestionnaires completed for annual 
egistration. The programs should be 
! :onducted jointly by the CNA and the 
)rovincial specialty groups. 
, Ensuring continued competence 
I)resents another problem, but with a current 
"entral registry this could be aChieved by 
lequiring endorsement by colleagues, and 
etesting, at regular intervals for example, 
3very five years. 

Inevitably, nursing will become more 
,3pecialized: the groundwork has been laid, the 
reed has been documented repeatedly, and 
row we are ready to move into planned 
I Most important is the need to define, 
igncourage, and recognize specialization; as a 
profession we should be working towards it 

ow The change will take some time, but we 
must begin to consider attendance at nursing 
meetings and education courses a necessary 
'part of our continuing education. 
I As a profession, where do we want to go? 
!How do we want to get there? If specialization 
iis what we need, and certification is what we 
!want, we must complain more vociferously 
;about the obstacles and start removing them . 

Eleanor G. Pask (B.Se.N., R.N.) is Head 
Nurse in the ClinIcal Investigation Unit at The 
Hospital for Sick Children in Toronto. 

1 Newton, M. The growth of a nursing specialty. 
JOGN Nurs. 1:10-11, Sep.lOct. 1972. 
2 Committee for the Study of Nursing Education 
Nursing and nursing education in the United States. 
Report of the committee for the study of nursing 
education and report of a survey by Josephine 
Goldmarl<. New York, MacMillan, 1923. 
3 Weir, G.M. Survey of nursing education in 
Canada Toronto, University of Toronto Press, 

4 Murray, V.V. Nursing in Ontario. Toronto, 
Queen's Printer. 1970. (Ontario. Committee on the 
Healing Arts. Study) 
5 Baumgart, Alice Jean. A discussion paper on 
specialization in nursing. A summary report 
prepared for the Canadian Nurses Association, 
6 Hutchison, Dorothy J. Certification; a new 
impetus to continuing education. J. Contin. Educ. 
Nurs. 4:5:3-4, Sep.lOct. 1973. 
7 Murray, op. cil. 

Sometimes, baby gets 
more air than formula. 



That's why we make sooth ing, 
peppermint-flavoured Ovol 
Ovol is simethicone, an 
effective but gentle antiflatu- 
lent that relieves trapped air 
bubbles in baby's stomach and 
bowel without irritating gastric 
Ovol works fast. And that's a 
relief for baby. And for mother. 


Also available In adult-slrenglh 
cheWable tablets 


O"õl aP 






The Cen8dlen N...e 1977 


Since the publication of Marc Lalonde's A New Perspective Participaction posters in buses and subways, television anc
on the Health of Canadians in 1974, a public debate has radio advertisements about non-smoking and fitness all I 
ensued about the many health hazards that are self-imposed emphasize health promotion. Increased awareness has I 
, - obesity, lack of fitness, alcohol and drug abuse, smoking, prompted many people to seek better and healthier patterns 
etc. The media have helped to awaken the public to the of living and it is to the health professions that these people 
importance that individual lifestyles play on health. look for guidance. Obviously, nurses have an important rde 
\ I C ) to play in providing this help - but only if their professional 

 associations and schools of nursing can show them the way 

 In the article thatfollows, The Canadian Nurse takes a look at 

 what is going on in one province, British Columbia. 







From the tIme a few years ago when many traditional hospital schools of nursing transferred to the 
community college setting, some employers have voiced the opinion that the two-year-diploma 
graduate is not "experienced" enough. Does this mean that the graduate has not had enough 
clinical practice to have developed manual dexterity... or that she is unable to cope with a realistic 
patient load... or that she is not confident in her nursing care? Whatever the interpretation, the 
concern exists and one community college !hat is trying to do something about it is Okanagan 
College in British Columbia. What follows is an explanation of the philosophy and implementation of 
the diploma nursing program at that college. 

Judith M Skelton 



Preparation of nurses with RN certification has 
passed through many stages since Florence 
Nightingale introduced gentlewomen into the 
profession of nursing during the Crimean War. 
Early schools of nursing were established in 
hospital settings, with no standardization of 
curriculum content, clinical facilities or 
entrance requirements. Nearly every hospital, 
regardless of size, conducted a training 
program since by doing so it was assured of a 
continuing supply of low cost staff. In fact, 
however, the graduates of such programs 
nearly all went into private duty where the 
hours and pay were more reasonable. 
The introduction of registration for nurses 
in the early 1900's in Canada marked the 
beginning of a long, slow process of 
standardization of the educational 
prerequesites for affixing 'RN" after one's 
name. Until fairly recently, these educational 
requirements tended to be expressed in terms 
of the number of hours spent in a given setting 
rather than in terms of what competencies 
were developed - hence the idea that "it 
takes three years to become a nurse." 
Twenty-five years ago. Mildred Montag 
spearheaded the development of "associate 
degree" nursing programs that were based in 
U.S. community colleges. Community 
colleges, as they have developed in Canada 
and the U.S., are the logical setting for basic 
nursing education. They provide a 
post-secondary level education with a 
practical orientation, that leads to employment 
opportunities and/or university transfer. 
Because college nursing students are not 
required to provide service to a hospital, their 
clinical experiences can be more closely 
correlated with classroom learning and the 
overall course of study can be accomplished in 
a shorter period of time - hence the notion of 
"two-year college programs." 
In British Columbia, as in most parts of 
Canada, nursing education has traditionally 
taken place in hospital-based programs. This 
trend began to change when the British 
Columbia Institute of Technology (BCIT) 
instituted a nursing diploma program in 1967. 
In the early 1970's, an increasing number of 
community colleges throughout Canada 
offered nursing programs to students. To date, 
all of the hospital-based programs in B.C. 
continue to be three years in length while the 
college-based programs are two years. In 
contrast, in Ontario, until recently, there 
existed many two-year hospital-based 
programs which have all since moved into 
community colleges, while in Quebec, the 

CEGEP nursing programs are three years. But 
while the question of two-year versus 
three-year programs continues to be hotly 
debated. perhaps what we really ought to do is 
decide what competencies beginning RNs 
require and then decide how long and in what 
manner these competencies are best 
The competencies required of beginning 
RNs will, of course, change with the changing 
health needs of society and education 
programs will have to be flexible enough to 
adapt. Anticipating these changes, Okanagan 
College in Kelowna, B.C. has launched a new 
diploma nursing program which has some 
unique features. These features include: 
. focus on the nurse as a health promoter 
. a three dimensional curriculum 
. a cooperative education design. 
e Program Objectives 
It is anticipated that the graduate of the 
Diploma Nursing Program at Okanagan 
College will be prepared to: 
. assume a beginning staff nurse position in 
an acute, intermediate or extended care 
hospital, clinic, office or home care setting; 
. work under the general supervision of an 
experienced registered nurse. The more 
experienced nurse should be able to answer 
questions and give general direction to the 
new graduate. In fact, it is hoped that 
graduates of the Okanagan College program 
will require less supervision, direction and 
support than other college graduates, as a 
result of having had "real work" experience in 
the course of their training. 
. work within a framework of written policies 
and procedures; 
. provide non-specialized, health-oriented 
nursing care to a group of patients. It is oyr 
belief that preparation for specialization is 
beyond the scope of a diploma program. 
. write the provincial nurse registration 

Within this context, the graduate will 
1. Communicate effectively with patients 
and colleagues. 
- demonstrate skill and sensitivity in human 
relations and communication 
- demonstrate skill in health teaching 
-provide leadership in small groups of clients 
and auxiliary nursing personnel 
- collaborate with other health team 
members in the provision and coordination of 
quality care. 


The Canedlan N
.e March 1977 

2. Provide quality nursing care to one or more 
patients requiring non-specialized. nursing 
- use the nursing process to provide 
individualized nursing care to patients: gather 
data, identify actual and potential 
needs-far-help, set priorities, plan, implement, 
and evaluate nursing care 
- involve the patient and his significant others 
in the plan of care 
- demonstrate skill and confidence in the 
application of non-specialized nursing 


3. Demonstrate professionalism in the delivery 
of nursing care. 
- seek to maintain and improve the health of 
self and patients 
- act as a patient advocate 
- exercise professional rights and 
- demonstrate an open-minded and 
constructive attitude toward changes in health 
care and nursing practice 
- assume primary responsibility and 
accountability for maintaining one's own 
competence in nursing practice. 
While these objectives may not appear to 
be especially unique for a nursing curriculum, 
the way in which we fulfill the objectives is 
rather unique. 
.. The Nurse as a Health Promoter 
- The promotion of health is a current and 
important topic of discussion among all health 
professionals. When Canada's present health 
care system was established, the causes of 
death and disease in the population were 
markedly different from what they are today. 
The current situation shows that "diseases of 
excess" due to alcohol and drug abuse, 
smoking, overeating, lack of exercise, etc. 
probably account for 50% of illness in our 
society. Besides this, escalating costs for 
health services demands that a less expensive 
approach to health - an alternative to the 
"disease orientation" - be found. People are 
becoming increasingly aware that they are not 
at their optimum level of health and are 
beginning to seek direction and guidance 
in improving this situation. The health 
professional of the future must take some 
responsibility for giving this direction. 
Accordingly, a primary focus of the total 
nursing program at Okanagan College is on 
the role of the nurse in health promotion. 
Fundamental to this approach is the idea that 
the nurse must be a good role model of health. 
Therefore, it is expected that both students 
and faculty be actively engaged in improving 
their own health status. 

.. Curriculum 
_ The framework or foundation for our 
nursing curriculum may be visualized as a 
cube. In the first dimension are those qualities 

.Non-apeclalized nursing care - the nurSing care of Infants. 
children and aduns exclusIVe of that reqLJredby cnt.cally 'II or h'gh nsk 
patients. (Oeflmtlon adopled from Draft Slatement of RNASC Task 
Committee to Identify cntlcal components á a BasIc Nursing 

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which nursing students must develop. These 
include effective communication, a logical and 
effective approach to nursing care, and 
professionalism. In the second dimension are 
the various stages of life with which nurses 
must be familiar. These stages include 
infancy, early childhood, middle childhood, 
adolescence, early adulthood, middle age, 
and later maturity. 
Finally, nurses must have a focus for the 
nursing care they provide. At Okanagan 
College, we view man as a being who is 
constantly responding to stimuli. These stimuli 
arise from three sources: from his 
development, from his lifestyle, and from 
unpredictable events. Some of his responses 
to these stimuli will be healthful, and others 
unhealthful. It is the nurse's role to try to 
increase the number or quality of healthful 
Growth in all three dimensions of this 
framework is planned to occur simultaneously 
throughout the program. As the students 
tackle new concepts in nursing care, they will 
move from: 
simple -- complex 
general - specialized 
health - illness 
single patient - multi-patient 
single problem - multi-problem 
team member - team leader. 
Clinical practice will be concurrent with 
classroom work throughout to allow immediate 
application of new knowledge 

Framework for the Nursing 



.. Cooperative Education 
.. Over the past several years, employers 
have voiced concern that graduates of 
two-year diploma nursing programs "haven't 
had enough clinical practice." It is difficult to 
know precisely what is meant by this phrase- 
.one person may mean not enough practice to 
have developed good manual dexterity; 
another may mean not enough practice to be 
able to cope with a realistic patient load; a third 
may mean not enough practice to be 
self-confident in giving nursing care; and still 
another may mean not enough practice to be 
able to function in various specialty areas. 
Whatever the specific meaning, the concern is 
very real. 
In an attempt to deal head-on with this 
problem, we have lengthened the Okanagan 
College program to two-and-one-half years 
and adopted a Cooperative Education Design. 
To my knowledge, this is the only nursing 
program in Canada to utilize such a design 
although universities such as the University of 
Waterloo in Ontario are using a similar scheme 
for other programs such as engineering. A 
very few American nursing programs have 
experimented with this ,concept. 
Cooperative Education is a college 
program within which students are employed 
for specific periods of off-campus work as a 
required part of their academic program. This 
employment is related as closely as possible 
to the student's course of study and individual 

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Cooperative Education schemes are 
motivated by the belief that education ought to 
prepare students, not only for a specific job, 
but also for the growing and adapting they will 
have to do. Wor\< experience rounds out 
education, eases the progression from 
knowledge to performance, and satisfies the 
need for reality in leaming.' 
The Board of Directors of The National 
Leag ue for Nursing (1972) emphatically stated 
that in orderto prepare the qualified personnel 
needed for the future, nursing education must 
become more flexible and provide increasing 
amounts of cooperative and collaborative 
arrangements for nursing education. A 
Cooperative Education design provides these 
In addition to receiving the clinrcal 
instruction which is a required part of all 
nursing education curricula, cooperative 
nursing students have the opportunity to 
consolidate their nursing knowledge and skill 
while observing and participating in current 
methods of health care. This experience leads 
to more competent and confident graduates 
who are better able to cope with the realities of 
their wor\< situations. and avoids the "Reality 
Shock in Nursing" which has received so 
much attention of late. 
Our students will attend Okanagan 
College during the regular fall and winter 
semesters for 2 1/2 years. During these "study 
semesters" they will take health science, 
nursing and non-nursing support courses, 

Cooperative Education Design 
for Nursing Program 

complemented by an average of two days per 
week clinical practice. In the summers the 
students will enter 12-week "wor\< semesters" 
during whIch they will wor\< a full shift rotation, 
carry a realistic patient load and generally 
consolidate the knowledge and skills acquired 
in the previous two study semesters. We 
believe that the wor\< semesters will assist our 
students to: 
(a) demonstrate better manual dexterity; 
(b) carry a more realistic case load; and 
(c) be more self-confident 
than graduates of traditional College 
In the first work semester the students will 
be hired as summer relief staff by local 
hospitals. They will replace ancillary nursing 
personnel who are on vaCéÏtion. The students 
will function as hospital employees according 
to a jOb description which is mutually 
satisfactory to the institutions and the College. 
They will be paid nurse's aide wages in 
accordance with the B.C. Hospital Employees 
Union contract. The students will not receive 
direct supervision from a College faculty 
member. However, someone from the College 
will be "on call" to assist the students and/or 
employers to wor\< through any problems or 
In the second work semester - due 
primarily to the difficulty in determining within 
whose jurisdiction the students would fall - 
the students will serve a preceptorship. Each 
student will be assigned to a competent RN for 

Fall Winter Summer Fall Winter SU'1lmer Fall 
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the semester. The student will work the same 
shift, have the same days off and share the 
duties and responsibilities of the graduate. 
He/she will remain a student and will receive 
indirect supervision from a College instructor 
Students will not be paid by the hospital during 
the second work semester but will continue to 
receive the provincial govemment monthly 
stipend which at present is $150.00. 
In summary. we have attempted, In 
planning the Diploma 
ursing Program at 
Okanagan College. to retain the positive 
aspects of existent hospital and college 
programs. while at the same time developing 
some unique features: a health promotion 
focus. a comprehensive curriculum framework 
and a cooperative education design. As yet. in 
this first year of the program. it is too early to 
predict outcomes, but we anticipate that our 
students will be better equipped to deal with 
the reality of a work situation. .. 

Judith M. Skelton received her B.S.N. from 
McMaster University, Hamilton, Ontario in 
1969 and her M.S.N. from the University of 
SritishColumbia, Vancouver in 1973. She has 
had experience in general duty and public 
health nursing as well as teaching experience 
in two. three and four year nursing education 
programs. At present. she is the Co-ordinator 
of Nursing Education, Okanagan College, 

1 Peregrym, John. Cooperative Education. 
Unpublished document, Castlegar. B.C., August. 




The Cenedien NU'se Merch 1977 

Adopted as an official position paper by the Board of Directors of 

The nurse's role in health assessment 
and promotion 

The promotion of health is a current and important topic for all health 
professionals. Causes of death and disease in today's civilized world are 
markedly different than when our present health care system was 
established. Costs of Illness care in Canada are rising at truly intolerable 
rates. A less expensive approach to health is not only desirable, but 
Lay peopie are becoming aware of their lack of wellness and are seeking 
direction in selecting a path to belter heatU"'. Many entrepreneurs have 
capitalized on this situation by providing false and often expensive guidance. 
To assure relevance to the health needs of today, health professionals must 
accept that they have a role to play in giving direction to the "worried well." 

o Philosophical Assumptions 
The philosophical assumptions guiding this paper on the nurse's role in 
health assessment and promotion are as follov.s: 
1. Health. a dynamic process occurring throughout the life cycle. implies 
continuous adaptation of lifestyle to anticipated and unanticipated events. 
2. Health implies the selection and utilization of individual. family and 
community resources. Each person has both the right of access and the 
responsibility to use these resources to maintain his health. 
3. An individual's values and altitudes about health can be changed by life 
experiences and/or interaction with significant others. Nurses. as members 
of the health care team can be the significant others. and in that way 
contribute to a person's health assessment and promotion. 
4. The nursing process is an interpersonal problem-solving approach which 
is used for the assessment and promotion of a person's health. 


o Definition of Terms 
Health: a state of complete physical. mental and social well-being and 
not merely the absence 01 disease or infirmity;1 "not only adding years to our 
life. but life to our years. "2 
Health Assessment: a systematic process of collecting and interpreting 
information relative to an individual's state of physical, mental and social 
Health Promotion: a process which encourages individuals 10 adopt a 
lifestyle compatible with optimal health. 
Lifestyle: an individual's habitual and characteristic pattern of living. 
Optimal Health: the highest degree of physical. mental and social 
well-being achievable by an individual at any given time. 
Stress: a physical and emotional state always present in the person. 
intensified when environmental change or threat occurs intemally or 
externally to which he must respo:ld. 3 
NUrsing: The RNASC in its Position Paper on Nursing Practice. 
accepted the following definition of nursing: 
The unique role of the nurse is to assist the individual. sick or well. in the 
performance of those activities contributing to health or its recovery (or to 
peaceful death) that he would perform unaided if he had the necessary 
strength. will or knowledge. 4 
This association feels that this definition, by its inclusion of the words "well" 
and "health," clearly identifies the fact that a significant part of nursing care is 
health promotion. 
Giving further weight to this concept is Marc Lalonde's exposure of the 
facts that: 
self-imposed risks and the environment are the principal or important 
underlying factors in each of the five major causes of death between age 
one and age seventy... 5 and 
diseases ofthe cardiovascular system. injuries due to accidents, respiratory 
diseases and mental illness, in that order. are the four principal causes of 
hospitalization. accounting for some 45% of all hospital days. 6 
Lalonde further states: 
one can only conclude that. unless the em<ironment is changed and the 
self-imposed risks are reduced. the death rates will not be significantly 
improved. 7 
It seems safe to assume that morbidity statistics will not alter unless 
these factors are dealt with as well. As one strategy for improving the overall 
health of Canadians. Lalonde suggests: 
The continued extensIon of the role of nurses and nurse practitioners in .,. 
counselling on preventive health measures, both mental and physical. and 
in the abatement of environmental hazards and self-imposed risks. 8 

o Principles 
Two principles form the basis for this paper: 
1. Nurses must accept responsibility for optimizing their own health. 
2. Nurses must accept their role and responsibility to sensitize others to the 
need to optimize their own health. 
Health assessment is the first step in any program or plan for health 
promotion. Health assessment is defined as collecting and interpreting 
information relative to an individual's state of physical. mental and social 
well-being. Effective health assessment requires knowledge and skills on the 
part of the nurse, appropriate technology, and inter- and intra-professional 
cooperation. The range of skills is wide. inCluding manual, managerial, 
attitudinal and communicative aspects. 
Health promotion is defined as a process which encourages individuals 
to adopt lifestyles compatible with optimal health. To be effective as a health 
promoter. the nurse first must be a role-model of health. Moreover, she must 
have special knowtedge and skills. access to appropriate technology and 
resources, and an ability to collaborate with other health workers. 

o Functions 
All practicing registered nurses should perform at least the following 
functions in relation to health assessment and promotion 
Health Assessment: 9 
1. Assessment of physical status 
2. Assessment of psycho-social status 
3. Assessment of lifestyle status. 
Health Promotion: 
1. Se a role-model of health 
2. Act as a change agent with/for patients 
3. Encourage lifestyle actIVIties compatible with optimal health 
4. Collaborate with other health workers in providing health-oriented care 
5. Support those policies. procedures and activities which promote health. 
According to their level of mterest and pleparation, individual nurses 
may take more active roles in health assessment and promotion. Table A 
contains one suggested format fOl obtaining appropriate data relative to self 
and patients, regardless of the selting in which they are found. A variety of 
other appropriate assessment tools are also available. Table S contains a 
suggested list of activities which nurses may perform in promoting health. 
In conclusion. that nurses have a role in health assessment and 
promotion seems hardly a malter for debate. The problem is preparing and 
encouraging nurses to fulfill this role. To this end. the following 
recommendations have been approved by the RNASC Soard of 
- Thatthe RNASC officially adoplthe Position Paper on the Nurse's Role in 
Health Assessment and Promotion. 
- That the position paper be published in RNABC News; moreover. that it be 
widely circulated to other nurses and related health workers. 
- That funds be allocated in the RNASC budget to assure that the role of the 
nurse in health assessment and promotion be properly initiated (e.g. 
continuation if appropriate of the 1976 project designed to sensitize members 
to their role in health promotion). '" 

1 World Health Organization, Constitution, Geneva. Palais des Nations. 
1960, p. 1. 
2 Marc Lalonde. A New Perspective on the Health of Canadians. 
Ottawa, Govemment of Canada. 1974, p. 6. 
3 Ruth Murray and Judith Zentner, Nursing Concepts for Health 
Promotion, New Jersey. Prentice-Hall, Inc. 1975. p. 160. 
4 Registered Nurses' Association of Sritish Columbia, Position Paper on 
Nursing Practice. RNASC. 1973. p. 2. 
5 Lalonde. A New Perspective on the Health of Canadians. p. 15. 
6 Ibid. p. 23 
7 Ibid. p. 15 
8 Ibid. p. 71 
9 Murray and Zentner. Nursing Concepts for Health PromotIon. pp. 

) .he Registered Nurses' Association of British Columbia 
Health Assessment 

Table A 

1. Assessment of physical status, 
1.1 state of growth and development 
a.physiological developmental tasks to 
be accomplished at this stage 
1.2 circulatory status 
a.character of pulses 
b.character of blood pressure 
c. movement of fluids (e.g. edema) 
1.3 respiratory status 
b interterence with respirations 
1.4 fitness status 
a. fitness test hazard appraisal 
1.5 motor ability status 
a. current mobility status 
c. range of joint motion 
d. muscle and nelVe status 
e. coordination 
1.6 status of physical rest and comfort 
a.sleep and/or rest pattern 
b. presence of pain. discomfort. 
restlessness. etc. 
c. use of supportive aids 
1.7 nutritional status 
a.condition of buccal cavity 
b.ability to masticate 
c. ability to swallow 
e.ingestion of nutrients 
1. digestion of nutrients 

1.8 elimination status 
a. bowel 
b. bladder 
1.9 reproductive status 
a.external genitalia 
b.age at menarche 
c. pattern of menses 
d. pregnancies 
1.10 body temperature status 
a. range 
1.11 status of skin and appendages 
1.12 status of special senses 
c. taste 

2. Assessment of psycho-social status, 
2.1 stage of growth and development 
b.psycho-social developmental tasks to 
be accomplished at this stage 
2.2 demographic status 
b.marital status 
c. relatives 
d.occupation status 
f. housing 

2.3 ethno-cultural status 
b.ethnic origin 
c. rehgion 
2.4 mental status 
a.state of consciousness 
c. intellectual capacity 
d.insight into health status and/or 
2 5 personal status 
a. motivation/ readiness 
b.strengths. weaknesses. limitations 
c.stress factors 
d.risk factors 
2.6 interpersonal relationship status 
a. family 
b.significant others 

3. Assessment of lifestyle status 
3.1 effects of daily habits 
3.2 effects of work 
3.3 effects of culture 
3.4 effects of home and work environment 
3.5 commercial products and/or 
environmental circumstances detrimental 
to health 

Table B 

Health Promotion 

1. Be a role model for health 2. Act as a change agent with/for i. current immunization 
1.1 maintain physical health patients j. appropriate management of chronic 
a.undertake an appropriate physical 2.1 use appropriate motivational approaches disorders 
activity program a.establish a trusting relationship k. appropriate use of community 
b.cope with stress b. increase clients' self-esteem resources 
c. avoid harmful products and c. identify and enlist support of significant I. accountability for health maintenance 
circumstances others 
d.ensure proper nutrition 4. Collaborate with other health workers 
e.keep immunization current e. partici pate in providing health-oriented care 
1. have regular check-ups f. induce anxiety and/or guilt a.knowown role and limitation 
g.plan for relaxation and sleep 2.2 get patient commitment to change b.refer appropriately 
1.2 maintain psycho-social health 2.3 assist in the formulation of realistic goals c. cooperate 
a.strive for positive interpersonal and priorities 
relationship 2.4 reinforce health responses 5. Support those policies, procedures 
b.increase self-esteem 2.5 provide anticipatory guidance for each hfe and activities which promote health 
c. avoid harmful circumstances stage a. health-oriented institutional health/role-models philosophies 
e.have regular check-ups 3. Encourage lifestyle activities standards and guidelines 
f. anticipate developmental tasks rather compatible with optimal health c. health-oriented institutional policies. 
than just living in the here and now a.appropriate physical activity program procedures and routines 
1.3 adopt a healthy lifestyle b.adequate rest and relaxation d. health-oriented evaluation procedures 
a.cope with stress c. avoidance of harmful products and and criteria 
b.avoid harmful products and circumstances e. health-oriented community and pOlitical 
ci rcu mstances d. identify and cope with stress involvement 
c. adjust own concepts of health and e. regular check-ups 
fitness f. fluoridation 
d. set realistic goals. priorities. guidelines g.good hygiene 
e. assume accountability for own health h.proper nutrition 


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The Can8dlen N.... March 1977 

Ellen Hodnett 

Lrl]1PillI1 W]@LlJD1P@wDLlJ@ 

An increasing number of hospitals in North America are 
buying fetal monitors for the purpose of assessing fetal 
health just prior to delivery. There are many who see the 
use ofthe electron ic device as a means of reduci ng North 
America's high perinatal mortality rates. However, 
continuous electronic fetal monitoring has its critics: 
those who term it an 'expensive gadget', those who say it 
increases the primary cesarian section rate, that its 
recordings are difficult to interpret, that it constitutes a 
risk to mother and fetus, or that it depersonalizes the 
relationship between an obstetrical nurse and her 
patient. Are fetal monitors worth the money, time, 
training, and risks involved? 


Critics of electronic fetal monitoring are 
adamant in their stand against its use. No one, 
they say, has proven that monitoring lowers 
perinatal mortality rates, adding perhaps that 
disadvantages to its use far outweigh assets, 
or that it only benefits high-fisk patients. Many 
hospitals buy the expensive equipment to let it 
sit alone and rarely used in an unobtrusive 
comer of the labor and delivery suite. 
What about the proponents of fetal 
momtoring, those aCDvely involved in its use? 
As a labor and delivery nurse and instructor to 
undergraduate students in maternal and 
infant health, I felt that it was important to 
investigate what they had to say. 
I set out to answer the questions raised 
by fetal monitoring by reading about the 
experiences of those who use it in a variety of 
hospital settings in North America. This article 
is based on the writings of those involved in 
fetal monitoring and associated research. 

D ways and Means 
Continuous electronic fetal monitoring 
involves the use of direct or indirect techniques 
to measure and continuously record both the 
fetal heart rate and the activity of the uterus 
during labor. 
The indirect method of fetal monitoring 
involves the use of two devices to be placed on 
the mother's abdomen during labor: a 
tochodynamometer to indicate the frequency 
and duration of uterine contractions and a 
transducer to measure fetal heart rate. 
The technique is non-invasive, 
with no inherent risks to mother or fetus. It can 
be used before the rupture of the membranes, 
and throughout all stages of labor. 
There are some problems evident with the 
use of indirect fetal monitoring. If the patient is 
obese Or restless, it is often difficult to obtain a 
clear monitor tracing. Some patients find it 
uncomfortable, and too restrictive to their 
freedom of movement. The information 
derived trom indirect fetal monitoring is 
somewhat lacking in two specific areas: it 
gives no data on beat-to-beat variability, an 
important indicator of fetal welfare; it provides 
no information on the strength of uterine 
contractions or on the resting tone of the 
The direct method of continuous fetal 
monitoring is an invasive method. A uterine 
catheter is inserted around the presenting part 
of the fetus and lies floating in the uterine 
cavity to measure the tonicity of the uterus. A 
spiral electrode is attached to the presenting 
part of the fetus to record the fetal 
electrocardiog ram. 

Direct fetal monitoring provides more 
specific data than the indirect technique and 
allows the patient more comfort and freedom 
of movement. However, the method is not 
without limitations. First, the membranes must 
be ruptured, the cervix one to two centimeters 
dilated, and the presenting part of the fetus no 
higher than -2 station. Secondly, there are 
risks to both fetus (such as neonatal scalp 
abscess) and to mother (such as uterine 
perforation), fortunately rare in occurrence. 
The procedure requires practice and technical 
skill on the part of the obstetrician inserting the 
catheter and electrode. Regardless of the type 
of monitoring used, fetal heart rate 
deceleration patterns do provide information 
about the welfare of the fetus. There are three 
significant deceleration pattems to watch for. 

 1 Early deceleration is thought to be 
due to fetal head compression during I 
contractions. The degree of heart rate 
slowing generally reflects the intensity 
of the uterine contraction Early 
deceleration is usually a benign 
pattern, transitory in nature and 
apparently well-tolerated by the fetus. 

 2 Late deceleration is thought to 
be due to utero-placental insufficiency 
and is ominous. It is frequently 
associated with high-risk pregnancies. 
uterine hyperactivity, and/or maternal 

 3 Variable deceleration is thought 
to be due to umbilical cord 
compression. It is also a pathologic 
pattem, but it can often be alleviated by 
changing the mother's position. 

at er? 



" .=.'1\ 
, . 1 









1973 Perinatal Mortality Statistics * 


(per 1000 live births) 
14.1 Canada 17.7 
14.6 Japan 18.0 
15.5 England and 
Wales 21.3 
16.3 Australia 22.4 
16.4 Scotland 22.7 
16.8 Federal Republic 
of Germany 23.2 


Hong Kong 

. World Health Statistics Annual Vol. t, Vital Statistics. Geneva. Switzerland. World Health 
Organization 1973-76. Table 5. pp. 15-18. 

Beat-to-beat variability can only be 
assessed through direct monitoring 
techniques. This term refers to the degree 
of short-term fetal heart rate fluctuations; 
average variability is defined as fetal 
heart rate fluctuations of 6-10 beats per 
minute. Because variability is due to the 
continuous interaction of the sympathetic 
and parasympathetic divisions of the 
autonomic nervous system, a decrease In 
variability indicates fetal distress. 
D Feta, Monitor vs. Fetoscope 
It appears that fetal monitoring 
can tell us a great deal about the 
welfare of the fetus. But what about the 
obstetrician who counters with the 
statement, "No machine can equal the 
skill of a competent labor and delivery 

nurse, armed with a fetoscope?" In a 
study of 24,863 labors, the fetal heart 
rate was taken every fifteen minutes 
during periods in the first stage of 
labor, and every five minutes during 
the second stage orduring any serious 
complications. However, only the most 
extreme cases of fetal distress were 
detected. Auscultation of the fetal 
heart rate proved to be a very 
unreliable indicator of fetal distress.' 
Furthermore, another source has 
stated that nurses relieved of 
"fetoscope duty" have more time to 
give emotional and physical comfort to 
their patients, that fetal monitoring 
need not be done at the expense of the 
comfort and well-being of the mother. 2 

D Effect on Primary 
Cesarian Section Rate 
There is some controversy as to 
whether fetal monitoring increases the 
primary cesarian section rate. One study 
indicates that monitoring resulted in a 
decrease in the number of cesarian 
sections necessary. Many deliveries 
which would have been performed by 
cesarian section because of auscultated 
fetal distress are managed conservatively 
because of the use of the more accurate 
electronic fetal monitor. The result was 
the delivery of healthy, non-depressed 
babies. 3 
A second source showed a decrease 
of about 75 percent in the primary section 
rate, with a resultant decrease in the 
number of depressed newborns. 4 
A four-year study in yet another 
setting indicated a definite rise in the 
number of primary cesarian sections, but 
there was a corresponding reduction in 
the perinatal mortality rate. s 
According to Dr. Edward Hon, 
variable deceleration IS the offending 
pattern in about 90 percent of fetuses who 
have been diagnosed as hin distress." In 
many hospitals, this "fetal distress" 
commonly contributes to the performance 
of a cesarian section. If patients were 
monitored, variable decelerations could 
probably be alleviated by maternal 
position change. which could prevent 
unnecessary cesarian sections. 6 
Although these SOurces show some 
disagreement as to the effect of fetal 
monitoring on the primary section rate, 
they do agree that overall, perinatal 
outcome is improved because of its use. 


Th. C.nlldl.n N.... March 1977 

.:: n . 
o. . 




\ :'.. . 

D Interpretation of Recordings 
Are the recordings difficult to 
interpret? Again, there is a difference of 
opinion. According to one author, 
although interpretation of abnormal fetal 
heart recordings may be difficult, a normal 
recording is decisive evidence in ruling 
out the possibility of fetal hypoxia? 
Other authors feel that fetal 
monitoring techniques are simple and 
convenient enough to be used routinely 
on an obstetric service, and that with little 
instruction there is minimal difficulty in 
recognizing a variety of fetal heart 
patterns and in being able to classify them 
as innocuous or ominous. 8 

D Who Should Be Monitored? 
Many authorities recognize that fetal 
monitoring is a necessity when the patient 
is classified as being of "high risk." One 
author found that late decelerations may 
persist for only thirty minutes before the 
fetus is severely compromised. 9 
What about the "Ion-risk" patient, the 
well-nourished, healthy, married 
twenty-two-year-old middle-class 
housewife who has had excellent prenatal 
care and is in labor at forty weeks' 
gestation? She is not a likely candidate for 
utero-placental insufficiency. However, 
cord compromise is estimated to occur in 
about one-third of all labors, according to 
blood gas and acid-base studies. 'o 
In an obstetric service practicing fetal 
monitoring on all patients in labor, 
researchers found that fetal distress was 
detected earlier, and that because of the 

resulting remedial action, there was a 
marked decrease in the number of 
newborns with low Apgar scores. 11 In 
addition, a normal fetal heart rate pattern 
has been found to be almost completely 
accurate in predicting high Apgar 
scores. 12 (It should be noted here thatthe 
five minute Apgar score is a useful 
predictor of long-term neurologic 
impairment).13 In 1972, Schifrin and 
Dame stated that not a single case of 
sudden unexpected fetal death has been 
documented on a monitored fetus. 14 
In another setting, deceleration 
pattems were seen in 52.8 percent of all 
monitored deliveries. One hundred and 
seventy eight of 749 patients showed cord 
complications during labor. '5 
One report compares the perinatal 
mortality rate in a large group of 
monitored patients with that of a larger, 
unmonitored group. Of 28.621 births, 
6,923 were monitored, approximately 25 
percent. For the most part, only high-risk 
patients were monitored. Ordinarily, this 
group would be expected to have a higher 
perinatal mortality rate. But in fact, the 
mortality rate in the monitored group was 
lower than in the low-risk, un monitored 
In another hospital, only high-risk 
patients were monitored. The results 
were so favorable as far as reduction "in 
perinatal deaths were concerned, that the 
service decided to use continuous fetal 
heart monitoring with all patients in 

D Cost vs. Value 
Strong evidence from several 
sources suggests that total fetal 
monitoring (Le. monitoring every fetus 
during labor) will halve the incidence of 
mental retardation and the yearly total of 
intrapartum deaths. '8 The cost of each 
monitor is about $6,000. It also costs to 
educate obstetric personnel in the 
interpretation of monitor recordings. The 
yearly increase needed to an already 
tightened hospital budget would, at first 
glance, make the concept of routine fetal 
monitoring, seem very impractical. 
In an article published in 1975, 
Quilligan and Paul included a cost 
analysis that included the cost of 
equipment, supplies, and the training of 
personnel. The added cost per patient 
was estimated at approximately $35.50; I 
on a nationwide scale in the United 
States, total fetal monitoring would cost 
$100 million per year. But it is estimated 
that by halving the incidence of mental 
retardation, savings to the taxpayer would 
be in the range of two billion dollars. It is 
also estimated that 6,000 intrapartum 
deaths would be prevented. Certainly 
these factors should be considered when 
cost of the monitors is being evaluated. 
D weighin g the Evidence 
My review of the literature on 
continuous fetal monitoring has 
convinced me of many things: 
. monitoring is not merely a fad; 
. it does not necessarily depersonalize 
the nurse-patient relationship and may 
even enhance it; 

An illustration of the indirect or 
external method of fetal 
monitoring. A tochodynamometer 
(at the top of the patient's 
abdomen) mdicates the duration 
and frequency of uterine 
contracüons. The transducer 
(lower on the patient's abdomen) 
indicates fetal heart rate. 

. it is inexpensive in comparison to the 
long-term costs of caring for the mentally 
retarded and the savings in terms of 
human resources are incalculable; 
. it mayor may not increase the 
primary cesarian section rate but it does 
increase the chances for a favorable fetal 
. interpretation of the recordings is a 
skill that can and should be learned by all 
obstetric personnel; 
. monitoring is as important to the 
low-risk fetus as it is to the high-risk fetus 
- while the former may not be subject to 
chronic utero-placental insufficiency, he 
is still at risk from cord compres
lon; there 
is currently no way to detect cord 
compression unless the fetus is 
monitored during labor. 
One of my questions remains 
unanswered by the literature: why do we 
delay? Our perinatal mortality rate is a 
cause for concern in compari son with that 
of many other countries. our statistics for 
cerebral palsy and other intrapartum 
tragedies are appalling. 
My reading convinces me that the 
eVIdence in favor of routine fetal 
monitoring is strong fl ." n dlcal, ethical, 
humane, and econo jp( - s. The 
benefits to be I '3'"'C "Ir.. rable. 
Why are \\ in North -\menca __ :>/ow to 
insure the" ,,- e of our greatest 
resourn. born children? '" 

1 Benson, Ralph C. Fetal heart rate as a 
predictor of fetal distress, by ... et aI. Obster. 
Gynecol. 32:2:266, Aug. 1968. 
2 Beazley, John M. The active management of 
labour. Amer. J. Obstet. Gynecol. 122:2:165, May 
15, 1975. 
3 Effer, S.B. Management of high risk 
pregnancy: report of a combined obstetrical and 
neonatal intensive care unit. Cansd. Med. Ass. J. 
101: 63, Oct. 4, 1969. 
4 Paul, Richard H. A clinical fetal mOnitor, by... 
and Edward H. Hon. Obstet. Gynecol. 
35:2:161-169, Feb. 1970. 
5 Tutera, Gino. Fetal monitoring: its effect on the 
perinatal mortality and caesarean section rates and 
its complications, by... and RObert Newman. Arner. 
J. Obstet. Gynecol. 122:6:750-754, Jul. 15, 1975. 
6 Hon, Edward H. Introduction to Fetal Heart 
Rate Monitoring. Unpublished. 1975. p. 35 
7 Simmons, S.C. Monitoring the fetus during 
labour. Nurs. Times 68:43:1350. Oct. 26, 1972. 
8 Paul and Hon, op cit. p. 168. 
9 Russin, Ann Woolbert. Electronic monitoring 
ofthefetus, by ...etaI.Amer. J. Nurs. 74:7:1299,Jul. 

10 James, L.S. The aod-base status of human 
infants in relation to birth asphyxia and the onset of 
respiration. by... et al. J. Ped/str. 52:379. 1958. 
11 Gabert. Harvey. Electronic fetal monitoring 
as a routine practice in an obstetnc selVlce: a 
progress report, by... and Morton A. Stenchever. 
Amer. J. Obstet. Gynecol. 118:4:534-537. FE'b 15, 
12 Schifnn, Barry S. Fetal heart rate patterns. 
Prediction of Apgar score, by...and Laureen Dame. 
JAMA 219:10:1322-1325, Mar. 6,1972. 
13 Drage, J.S. The Apgar score as an index of 
infant morbidity. A report from the collaborative 
study 01 cerebral palsy, by... et al. Develop Med 
ChIld Neurol. 8:2:141-148. Apr. 1966. 
14 Schifnn and Dame, op. Clt. p. 1324-1325. 
15 Gabert Harv9Y. Continuous electronic 
monitoring offetal heart rate during labour, by... and 
Morton A. Stenchever. Amer. J. Obstet. Gynecol. 
115:920, Apr. 1, 1973. 
16 Paul, Richard H. Clinicalletal monitoring vs. 
effect on perinatal outcome, by... and Edward H. 
Hon. Amer. J. Obstet. Gynecol. 118:4:529-533, 
Feb. 15, 1974. 
17 Tutera, op. cit. p. 754. 
18 Quilligan, Edward. Fetal monitoring: is it 
worth it? by... and Richard Paul. Obstet. Gynecol. 
45:1 :96-100, Jan. 1975. 

irect Fetal Monitoring 

Ellen Hodnett (RS.N., Georgetown 
University, Washington, D.C.) is 
presently working as Lecturer with the 
University of Toronto Faculty of Nursing 
teaching second and third year students 
in the undergraduate Baccalaureate 
program. Prior to 1975, Hodnett was Unit 
Administrator of the labor and delivery 
unit of North York General Hospital in 
Willowdale, Ontario. 


The Cenlldlen N..... Merch 1977 

. of the unlfor llb 

" Living with 

. Adult Still's Disease 


Being on the "receiving end" of medical and nursing care instead of the "providing end" can be a 
disconcerting experience forthose of us who rarely assume the role of the patient. The author of "The 
Other Side of the Uniform," sheds some light on the frustrations and anxieties that accompany the 
unknowns of an illness such as Adult Still's Disease. 

J t 


Yolanda Camiletti 

Everything seemed to be happening to me all 
at once... I had just graduated from university 
with a B.Sc.N. and a B.A. in psychology, a new 
jOb in an Emergency ward was waiting for me 
and in one month I was going to be married. It 
was great the way things were working out. 
Although the past three months had been 
stressful, I was just now beginning to get 
accustomed to my new life style. 
September rolled around and the hustle 
and bustle of the changing season was partly 
responsible for the streptococcal throat 
infection that I developed. Having had throat 
infections before, I thought nothing of it, and 
asked the doctor I was working with for an 
antibiotic. Ampicillin was prescribed. The next 
day, an itchy, pink rash developed on my arms 
and I felt flushed. Although I had taken 
Ampicillin as a child, it now seemed that I was 
allergic to it. Consequently, the Ampicillin was 
discontinued and replaced with Erythromycin. 
Thinking that the adverse side effects of 
the Ampicillin would disappear, I was 
surprised that at the end of a week, my 
temperature was still elevated (3B.5-39.5 0 C) 
and the pink, itchy, rash persisted becoming 
more evident at night. Another problem 
occurred as well - the fingertips of my right 
hand became very sore. I thought I might have 
injured them somewhere but I couldn't 
remember having done so. 
The next day, the soreness started again 
but this time in my right wrist, and became 
increasingly severe so that by evening, I was in 
excruciating pain. My temperature continued 
to rise and the rash which now covered my 
whole body was in full "bloom." My husband 
took me to the emergency ward of the local 
hospital. An X ray of my wrist showed no 
abnormalities and it was diagnosed as "some 
type of tendonitis!" The physician told me that 
if it persisted, I should see my family doctor. 
After a restless nighfs sleep, I woke up 
the next morning to find that my temperature 
was normal and that my rash had 


I Still's Disease, also known as 
juvenile rheumatoid arthritis, is a chronic 
systemic disease involving a wide 
spectrum of manifestations. All three 
forms of the disease - polyarticular, 
monoarticular, and acute febrile - have 
I arthritis as a symptom but the pattem of 
I joint involvement varies widely. In some 
I cases, the systemic manifestations may 
be more obvious than the arthritis. 
The etiology of the disease is 
unknown, but recent research suggests 
I that some factor, for example, a viral or 
bacterial infection. triggers the normal 
inflammatory response. It may be related 
to collagen and autoimmune diseases. It 

occurs 2-3 times more frequently in 
females than males, usually before the 
onset of puberty. 
The onset of the disease often 
becomes manifest after physical trauma 

o a joint or following an acute systemic 
infection. In its early stages, one or more 
joints may show signs of inflammation 
with stiffness, swelling, impaired range of 
motion and pain. The articular cartilage of 
the joints undergoes physiological 
change. Tendons, tendon sheaths, 
synovial tissue and muscle tissue may 
also be involved in inflammatory changes. 
Systemically, Still's Disease is 
characterized by severe fever (as high as 

41 c C), non-specific skin rashes, and 
enlargements of the liver, spleen, and 
lymph nodes. Anemia and cardiac 
involvement may also occur. The 
development of nodules is rare. 
In children, the disease may cause 
irreversible eye damage due to scarring 
and adhesions. Certain skeletal 
abnormalities may occur due to 
interlerence with the normal rate of 
growth espeaally in the cerVIcal spine. 
Simila r signs and symptoms occur in 
Lupus Erythmatosus and in allergic 
reactions to medication. It is important to 
rule out these diseases before making a 
diagnosis of Still's Disease. 

disappeared. My good fortune did not last long 
however. By late afternoon, the fingers and 
wrist of my left hand were becoming sore. It 
seemed that the joints affected followed some 
kind of symmetrical pattern. 
At this point I went to see my family 
physician. He felt that my symptoms were still 
due to my allergic reaction to the antibiotic and 
that after a couple of weeks, they would 
I disappear. So I waited for two weeks. 
Instead of getting better, however, I got 
worse. Every evening, my rash would emerge 
in pink-red blotches and streaks. Some areas 
of the rash were elevated, others weren't. 
There seemed to be no particular pattern to it 
and any area of my body that was scratched 
left a rash. The unique appearance of the rash, 
unfortunately, did not help the doctors in their 
I found that my feverw as always elevated 
in the evenings. More and more joints became 
involved, among them, my knees, shoulders, 
jaw and ankles. They began to swell and 
became reddened and hot to touch. The pain 
was very severe and at times would leave me 
One month after the onset of this illness, 
there was still no concrete evidence to support 
a specific diagnosis. So my family doctor 
referred me to a rheumatologist. Every 
possible blood test was done but they revealed 
little. The results showed that I had an elevated 
erythrocyte sedimentation rate, elevated white 
blood cell count and a decreased hemoglobin. 
Tests for Lupus Erythmatosus and the 
Rheumatoid Factor were both negative. 
During the physical examination the 
rheumatologist found that my spleen was 
enlarged. He also noted that I had a second 
grade systolic heart murmur. Xrays all came 
bael< negative. 
One morning, a little more than five weeks 
after the beginning of this "conundrum" (as my 
physician referred to it), I was unable to move. 
My body was stiff and it caused me 

considerable pain to make the slightest 
movement. My doctors felt that r should be 
admitted to hospital. 
There were rnany feelings racing through 
my mind at this time. I had not reached the 
"why me" stage of my illness but, instead, was 
in the "self-centered" here and now. I had pain 
and I wanted relief from this physical condition 
which was causing me discomfort and many 
psychological conflicts. 
For a long time, I had no certain or fixed 
diagnosis. This produced feelings of anxiety 
and fear. How would the doctors be able to 
treat me if they didn't know what to treat? Why 
didn't they know what to treat? Out of the 
millions of people in the world, could I be the 
only one with these symptoms? 
In hospital, it was strange to be on the 
other side of the uniform. I felt helpless, as 
though I had lost all strength and vigor. In 
familiar surroundings, where once I had been 
bouncing with energy, helping the sick by 
being "useful," I was now in the role of the 
"sick patient." The tables were turned and it 
was all the more difficult for me to accept my 
illness. Even the hospital bed with its side rails 
which should make a patient feel secure did 
just the opposite for me. It made me feel caged 
in, and very separate from my husband at a 
time when I really wanted to be close to 
There were many physiological, 
psychological and emotional problems that I 
had to deal with during my illness. Some of my 
feelings changed with time and reflection; 
others because I was able to talk them over 
with medical staff or with my family. 
Thatfl rst evening in hospital, r was given a 
number of different kinds of medication. 
Unfortunately, I was allergic to one ofthe drugs 
and developed a reaction to it. My eyes played 
tricks on me, nothing seemed to be in the right 
perspective, everything was hazy. I felt 
nauseated and my body was covered with a 
red rash. My confidence in the doctors was 

dwindling rapidly. Fortunately, my husband 
was able to stay with me until two o'clock that 
morning. However, by morning, instead of 
being better, I was worse, both physically and 
mentally. I felt like signing myself out of the 
hospital and going home. It seemed as though 
nobody was able to help me and that I was 
considered by the medical staff to be just a 
"specimen" with a rare illness. 
To add to my frustration, at about nine- 
thirty that morning, two teams of medical 
students were given the opportunity to 'view' 
my unusual rash. Although I realize that 
experience is the best teacher, I resented 
having ten student doctors examine my skin by 
checking for blanching and elevated areas. 
Besides feeling like the star of a 'freak show,' I 
was extremely uncomfortable since I was in 
pain. All this led me to an increasingly negative 
attitude towards my illness. 
Late that same afternoon, I was 
transferred to a medical floor where I spent the 
rest of my hospitalization. My memories of the 
first five days in this room are still obscure. I 
can remember the pain, nurses helping me to 
the bathroom, eating and sleeping. With my 
physical needs met, I had no interest in 
anything else. Although I was indifferent to his 
presence. my husband sat with me every day 
while I would either cry or sleep. 
By the sixth day. I had become more 
aware of my surroundings. Out of curiosity, 
fear and the hope of finding a cure for my 
illness, I questioned doctors and nurses on 
almost everything they did. I would get very 
angry when I received the wrong X ray, a 
double dosage of Prednisone or when the 
nurse canng for me had no idea of what my 
illness entailed. 
After several weeks of physical 
examinations, laboratory testing and careful 
observation of my signs and symptoms, a 
diagnosis of Adult Still s Disease was finally 
made. According to my rheumatologist, my 
treatment would consist of rest, medication 


Living with 
Adult Still's Disease 

The Cenlldlen Nuree March 1977 


and time. There was no instantaneous cure 
and since the cause is unknown, my doctor 
was only able to treat the symptoms. The drug 
of choice at this time was Prednisone 60 mg 
per day. 
It was not long after this that I was 
discharged from hospital and returned home. 
It was necessary to carry on with the medical 
regime and to begin to undertake normal daily 
chores. It was also important for me to realize 
my own physical limitations since almost every 
joint in my body was affected by the 
inflammatory process. Because of this, I had to 
be careful not to place too great a strain on my 
joints or to exercise them too strenuously. If a 
joint became reddened and sore one-half hour 
after exercising, then I had gone beyond my 
By the first week of December, three 
weeks after the onset of symptoms, I was sure 
that I was getting better. I could walk well, my 
joints caused me only minor discomfort and 
my Prednisone level which the doctor had 
decreased by 5mg per week, was down to 5 
mg every second day. 
However, two weeks later, my 
temperature became elevated each night, my 
rash retumed, my fingers were reddened and 
swollen and my other joints were sore. Again it 
was necessary for me to go into hospital during 
this exacerbation period. Prednisone 70 mg 
per day was prescribed. I remained in hospital 
until all the symptoms had stabilized. 
It is now many months since my last 
discharge from hospital. I am still taking 
Prednisone and continue to experience mild 
joint pain. I must still watch out for activities that 
might put too great a strain on my joints but I 
am able to do most things for myself. The side 
effects of the Prednisone such as moon face, 
fat deposits, weight gain and an elephant 
hump at the back of my neck are still apparent 
although subsiding. 

To conclude, I would like to stress some 
major points about Still's Disease: - 
. The disease itself has many unknowns. 
What we do know is that this illness is not the 
debilitating type of arthritis. 
. . Steroids do not cure the illness but serve 
only to alleviate the symptoms. It is important 
for the nurse and patient to realize the many 
side effects caused by this medication and to 
understand the physiological and 
psychological effects the drug may produce. 
. Due to the drug therapy which causes the 
suppression of symptoms, there is no method 
of detecting the different stages of the disease. 
. Steroid levels must be decreased very 
slowly. A rapid decrease may cause an 
exacerbation of symptoms. 

Tips for patients with Still's Disease 
. Relaxation - rest for 8 to 12 hours 
per day. 
. Avoid stressful situations, if possible. 
. Know your own limitations. Only you 
know how much you can do. Physical 
exercise is important to maintain joint 
mobility, but set your own pace. 
. Take medication as prescribed. 
. When joints become stiff and swollen, 
the besttherapy is rest. An ice pack or hot 
compress, whichever feels most 
comfortable, may help_ 
. Although the joints may not be visibly 
swollen, they may be sore. 
. Use self-help devices e.g. sit on a 
stool to do dishes, allow dishes to dry 
themselves, use electrical appliances 
such as a can opener. 
. Remember, healing takes time. 
Never give up. Start out slowly then 
progress. '" 

Yolanda Camllettl, (R.N., B.A.), authorofThe 
Other Side of the Uniform, worked for three 
months in an Emergency Department before 
the onset of her illness. After six months of ill 
health, she began the search for a new 
position. She states," Looking for work was a 
very frustrating experience. The general 
questions asked by employers were: 
1. When do you think you will have another 
2. Oh, you are still on medication? 
3. Do you think you can stand for 12 hours of 
the day? 
After another six months of searching for 
a position, I found an understanding 
exmployer at the Middlesex-London District 
Health Unit. 
At the time I started working with the 
health unit, I did have another exacerbation of 
symptoms. With the early recognition of 
symptoms, and prompt medical care, my 
recovery rate is progressing at a much faster 
pace than during the previous relapses. I was 
kept mobile and out of the hospital. I was also 
able to hold my position at the health unit. 
At this point, only time will reveal the 
course of my illness. It is my greatest hope that 
some day, someone, interested in 
researching this disease will discover the 
exact cause of the illness and perhaps even 
the cure." 

1 Beeson, Paul B. Textbook of Medicine 1300. 
by ._. and Walsh McDermott. Philadelphia, 
Saunders, 1971, p. 1,898. 
2 MacRae, Isabel. Arthritis: It's nature and 
management. Nurs. Clin. North Am. 8:643-52, Dec. 
3 Magalini, Sergio I. Dictionary of Medical 
Syndromes, Philadelphia, Lippincott, 1971, p. 495. 

Saunders fills your prescription 
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REED & SHEPPARD: Regulation of Fluid and 
Electrolyte Balance: A Programed Instruction in 
Clinical Physiology, t\ew 2nd Edition 
Individual self-study units progress from the least complex aspects 
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better understanding of these problems and the appropriate pa- 
tient care measures. 
By Gretchen Mayo Reed, BS, MA (Ed), MA (Bio), Univ. of Tennessee Center 
for the Health Sciences; and the late Vincent F. Sheppard, MEd, PhO. About 
350 pp. lIIustd. Soft cover. About $8.25. Ready March 1977. 
Order #7513-1. 

GCYTOX: Basic Human Physiology: Nonnal 
Function and Mechanisms of Disease, New 2nd 
Geared to the needs of student nurses, this text presents the same 
concepts and principles as in Guyton's Textbook of Medical 
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many of the qualifying explanations, and some of the references to 
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By Arthur C. Guyton, MO. Univ. of Mississippi School of Medicine, Jackson. 
About 930 pp., 420 ill. About $17.00. Just Ready. Order #4383-3. 

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Here's an excellent text with easily understood material, exciting 
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By Keith F. Moore, MSc, PhO, FIAC. Prof. and Chairman, Dept. of Anatomy, 
Univ. of Toronto. Faculty of Medicine. About 430 pp., 360 ill. Ready March 
1977. Order #6471-7. 

LEIFER: Principles and Techniques in Pediatric 

ursing, New 3rd Edition 
This comprehensive clinical nursing text; reference bridges the gap 
between theoretical knowledge of and practical skills in pediatric 
nursing. Completely up-dated and substantially expanded, you'll 
find added coverage of new equipment, inhalation therapy. dietary 
considerations, poisoning, drug interactions, and a whole new 
chapter on The Pediatric Outpatient and The Clinic Nurse. 
By Gloria Leifer, RN, MA, formerly of Hunter College of CUNY. About 350 
pp., 195 ill. About $10.05. Ready March 1977. Order #5713-3. 

GILLIES & ALYX: Patient Assessment and 
Management by the Kurse Practitioner 
This outstanding text provides specific guidelines for developing 
your skill in interviewing, physical examination, laboratory test 
interpretation, and psychosocial assessment. There are also prac- 
tical insights into the management of patients with Chronic illnes- 
ses such as hypertension, diabetes, osteoarthritis, arteriosclerotic 
heart disease, obesity, alcoholism, and chronic obstructive lung 
By Dee Ann Gillies, RN, EdO, the Dept. of Education, Heart and Hospitals 
Governing Commission of Cook County, Chicago: and 'reneB. Alyn, RN, PhO. 
Univ. of Illinois College of Nursing, Chicago. 236 pp. lIIustd. $9.00. April 
1976. Order #4133-4. 

U'CK\tA \:X & SORE\:SE:\": 
:\:ursing: A Psychophysiologic Approach 
In the two years since its publication, more than 125,000 of your 
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major systems and precise instruction in the nursing and medical 
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By Joan Luckmann, RN. BS. MA; and Karen Creason Sorensen, RN. BS. MN. 
1634 pp 422 III. $21.35. Sept. 1974. Order #5805-9. 

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CN 3 77 

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AFFIUATION (II Applicable) 







The Canadian Nurse March 1977 



Shirley Alcoe (B.A.; B.Ed.; M.A.; 
M.Ed.; Ed. D.) Associate Professor, 
Faculty of Nursing, University of New 
Brunswick, is the new Chairman of the 
Canadian TuberculosIs and 
Respiratory Disease Association 
Nurses' Section. She has previously 
worked as a staff nurse in Port 
Colborne, Ontario, Edmonton and 
Ottawa and in public health In New 
Brunswick. In 1965, she joined the 
World Health Organization and went 
to India to assist national nursing 
groups to provide short courses for 
ses. .Later she advised Bombay 
UniversIty on Nursing Curriculum. 
Alcoe has worked on planning 
comm Ittees for the New Brunswick TB 
and RD Association and has 
published several papers on health 
and physical education for students. 




11\ _. 

- -::::::::... 


Val Cloarec, executive director of the 
Saskatchewan Registered Nurses' 
Association since 1974, has resigned 
effective March 4, 1977, and has 
accepted the position of Director of 
Vital. Statistics, Department of Health, 
Regina, Saskatchewan. 
Cloarec is a native of 
Saskatchewan and since her 
graduation from Holy Cross Hospital 
School of Nursing in Calgary, has 
spent most of her time in the nursing 
field. She has worked as a staff nurse 
in hospitals in Saskatchewan and In 
the Northwest Territories, as well as 
having worked for the Department of 
Public Health as a staff nurse, regional 
nursing supervisor and nursing 

f .( 
_. \ 
H .-. ........ 

Nicole Fontaine has been appointed 
Director of Public Relations Services 
for the Canadian Nurses Association. 
A journalist, broadcaster and 
consultant, she has served. since 
1970, In various capacities with the 
Secretary of State, Health and 

elfare's Fitness and Amateur Sports 
Directorate, Federal-Provincial 
Welfare conferences, and more 
recently the Official Languages 
Branch and Communications Division 
of the Treasury Board. 
A graduate of the University of 
Ottawa, her expenence includes 
working for the French Govemment in 
Rabat (Morocco), newspapers in 
Paris, Ottawa and Montreal, Expo '67, 
advertising and town planning firms in 
Quebec, Radio-Canada in Vancouver 
and the 1970 British Commonwealth 
Games, at Edinburgh. 
Marilyn D. Willman has been 
appointed director of the School of 
Nursing, University of British 
Columbia effective July I, 1977. 
Willman, president of the state-wide 
University of Texas System School of 
Nursing, earned her B.Sc.N. from the 
University of Michigan in 1952. After 
working as a staff nurse and clinical 
instructorfor six years, she enrolled at 
the University of Texas where she 
received her master's degree 
specializing in administration in 
nursing education and her doctorate In 
educational psychology. She joined 
the faculty olthe University ofTexas in 
Willman succeeds Muriel 
Uprichard, head of nursing at U.B.C. 
since 1971, who has been an 
outspoken critic of what she termed 
the "hand-maiden servant" role 
assigned to nurses in many hospitals. 
She retires June 30, 1977. 

The Canadian Council of 
Cardiovascular Nurses has 
announced its board of management 
for 1977. Members of the Executive 
Committee are: 
Chairman: Carolyn Stockwell, 
Windsor, Ont.; 
Past Chairman: Joan Breakey, 
Vice-Chairman: Cecile Boisvert, 
Montreal, Que.; 
Recording Secretary: Therese 
Poupart. Boucherville, Que.; 
T,easurer: Jane Wilson. Toronto, 
Membership Secretary: Madeleine 
McNeil, Dartmouth, N.S.; 
Provincial representatives are: 
Alberta: Kathryn Bradley, Edmonton; 
British Columbia: Judith Shields, 
New Westminster; 
Manitoba: Gina Taam. Winnipeg; 
New Brunswick: Helene Roy, 
Nova Scotia: Anna Freeman, Halifax; 
Newfoundland' Glenys A. Whelan, 
St. John's; 
Ontario: Isabelle Kemp, Sudbury; 
Prince Edward Island: Barbara 
Baglole, Charlottetown; 
Quebec: Francine Beauchamp, 
Saskatchewan: Toni Beerling, 
Registered nurses interested In 
cardiovascular health care are invited 
to join the C.C.C.N. Write: 
Canadian Heart Foundation, Suite 
1200, One Nicholas St., Ottawa, 
K1N TB7. 

Rachel Palmer of Bunjul, Gambia has 
been elected President of the 
Commonwealth Nurses Federation. 
Forty national nurses' associations of 
Commonwealth countries are now 
members of the Federation. 

Leona Margaret Bowes has been 
honored by the University of 
Saskatchewan as the most 
distingUished graduate In nursing at 
the fall convocation. 

New Appointments 

Sandra A. E. Rencz. (R.N. Kingston 
General Hospital, Kingston, Ontario; 
B.N., McGill University) has been 
appointed lecturer in nursing at The 
University of New Brunswick, 
Fredencton. Her pnmary 
responsibilities at U.N.B. will be 
clinical teaching in the nursery area, 
pediatrics and obstetrics. 

Faye Birt has recently joined the staff 
of the Prince Edward Island Nurses' 
Provincial Collective Bargaining 
Committee as an Employment 
Relations Officer. Faye, a graduate of 
the Prince Edward Island School of 
Nursing, was employed by the Prince 
Edward Island Hospital, 
Charlottetown, P.E.I., and served as 
President of their Staff Association. 

I/1IfAo _ 


Patricia A. Phillips (R.N., Vancouver 
General Hospital; B.Sc.N., University 
of Alberta) has been appointed 
MEDICO project director of a 
14-member CARE/MEDICO team 
that conducts training programs for 
physicians, nurses and laboratory 
technologists. Based in Sarakarta 
(Solo), Indonesia, she will also 
coordinate a newly planned 
community health program which will 
extend into rural areas. 
Phillips has had extensive 
s nursing experience having 
worked In South Africa and with CUSO 
in India and Bangladesh in 
mother-child health centers and family 
planning projects. 




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Issues In Community Health to be 
held March 28-April 1, 1977 at the 
Academy of Medicine, Toronto. Public 
Health Nurses and those interested in 
community health issues invited. 
Contact: Grace Batchelor, 
Coordinator of ContinUIng Education, 
Division of Community Health, Room 
124, Fitzgerald BUIlding, University of 
Toronto, Toronto, Ont., M5S IAI. 

Nursing and the Law - a one-day 
seminar for nurses and allied health 
professionals to be held on March 19, 
1977 at the University of New 
Brunswick, Fredericton, New 
Brunswick. Guest lecturer - Mr. 
Lome Rozovsky. Contact: Carole 
Estabrooks, President, Nursing 
Society, Faculty of Nursing, 
University of New Brunswick, 
Fredencton, New Brunswick, 
E3B 5A3. 

Foundations of Hospital 
Management - A three-day program 
for managers from all hospital 
departments. To be held in Montreal 
on March 16-18, 1977 and in Toronto 
on March 23-25,1977. Tuition: $120. 
Contact: A.M. Brown Consultants 
1115-1701 Kilbom Ave., Ottawa, Ont. 
K1 H 6M8. 

The Executive Nurse - A three-day 
program for nurses in management 
positions. To be held in Vancouver on 
March 9-11,1977, and in Toronto on 
April 20-22, 1977.Tuition $120. 
Contact: R.M. Brown Consultants, 
1115-1701 Kilborn Ave., Ottawa, 
Ont., K1H 6MB. 

Workshop in Psychodrama at the 
Clarke Institute of Psychiatry, Toronto 
on March 17-18, 1977. Contact: 
Dorothy Brooks, Chairman, 
Continuing Education Program, 50 St. 
George St., Toronto, Ont. M5S 1Al. 

The Management of Motivation - A 
two-day program for all health 
services managers. To be presented 
in Montreal on March 14-15, 1977. 
Tuition: $100. Contact: R.M. Brown 
Consultants, 1115-1701 Kilborn Ave., 
Ottawa, Onto K1 H 6MB. 

Annual Meeting of the Canadian 
Nurses Association, 31 March 1977, 
Ottawa. Contact: The Canadian 
Nurses Association, 50 The Driveway, 
Ottawa, Ont., K2P 1E2. 


The Grieving Process and the 
Dying Process at the University of 
Toronto on Wednesday evenings April 
6 - May 25, 1977. Contact: Dorothy 
Brooks, Chairman, Contmuing 
Education Program, 50 St. George 
St., Toronto, Ont. M5S IAl. 

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You'll discover that all major nursing specIalty and sub-specIalty 
areas are available here. Let us supply you wIth more reasons 
nurses are choosing Galveston. Our representatives will be in 
Canada in early April. To wrote lor locatIons, contact. Gary 
Clark, Dept. 01 Nursing, UTMB HospItals, Galveston. Texas 
An equal opportunoty m/f affirmatIve actIon employer. 


First International Congress on 
Toxicology to be held March 30 - 
April 2, 1977 in Toronto, Ontario. 
Contact: Dr. Robert G. Burford, 
Secretary,ICT, c/o G.D. Searle & Co. 
of Canada Ltd., 400 Iroquois Shore 
Road,Oakville, OntBlio. L6H 1M5. 


Intensive Care Symposium. 
Lectures in Cardiology, Neurology, 
Respiratory Problems, and 
Hyperalimentation. To be held at 
Selkirk College, Castlegar, B.C., on 
May 28-29, 1977. Contact: Ms. Sandra 
Rubin, Kootenay Lake District Hospital, 
3 View St., Nelson, B.C. 

Oncology Nursing Society Second 
Annual Convention to be held in 
Denver, Colorado on May 15-16, 
1977. Contact: Ms. Daryl Maass, 
Secretary, Oncology Nursing 
Society, N. Y.U. Medical Center, 560 
First Ave., New York, N. Y. 10016. 

Getting Through to People - A 
two-day workshop to improve 
communication skills. To be held in 
Toronto on May 9-10, 1977. Tuition: 
$120. Contact: R.M. Brown 
Consultants,1115-1701 Kilborn Ave., 
Ottawa, Ont. K1 H 6MB. 

The Educator-Manager - A 
three-day program for directors, 
coordinators and instructors in staff 
development and inservice education 
departments, to be held in Toronto on 
May 11-13,1977. Tuition:$120. 
Contact: R.M. Brown Consultants, 
1115-1701 Kilborn Ave., Ottawa. 

Intensive and Rehabilitative 
Respiratory Care presented by the 
Pulmonary Division of the University 
of Colorado Medical Center. Denver, 
Colorado, May 23-27, 1977. Fee: 
$150. Contact: American College of 
Chest Physicians, 911 Busse 
Highway, Park Ridge IL, 6006B. 

Association for the Care of 
Children in Hospitals Annual 
Conference, "Speaking Out for 
Children," in Dearborn, Mich., May 
25-28, 1977. Contact: Mary F. 
Podolak, R.N., Childre'),s Hospital of 
Michigan, 3901 Beaubien Blvd., 
Detroit, Michigan 4B201. 


Nursing Care of the Patient 
with Burns by Florence Jacoby. 
(2ed.) St. Louis, C.V. Mosby, 
Approximate price $7.30. 
Reviewed by Mary Shields, R.N., 
B. ScN , Clinical Instructor, 
School of Nursing, University of 
Alberta Hospital. 

A book devoted to nursing care of 
a patient with burns is very rare 
and consequently the new edition of 
Florence Jacoby's text was most 
As in the first edition, Jacoby 
covers general topics such as the 
incidence of burns, and the history of 
burn treatment. She also discusses 
specifics in anatomy, 
pathophysiology, nutrition, 
complications, and related nursing 
The book is written in an 
easy-flowing style, but is very detailed 
in topic coverage in its 175 pages. 
J was pleased to see two new 
chapters included in the second 
edition. One of these deals with the 
volume and composition of fluid 
therapy. This chapter opens up the 
controversy concerning what kind of 
fluid and how much of it is to be given 
to burned individuals during the acute 
phase of their illness. 
The second new chapter is called 
a 'Teaching Appendix.' It is divided 
into theoretical and clinical objectives, 
with review topics and content clearly 
and concisely listed. As IS stated: 
"They can be adapted to fit 
undergraduate. graduate. in-service, 
and continUing education plograms." 
In the remainder of the book, I 
discovered a very thorough updating 
of all topics. Where relatively new 
advances have been made, (for 
example in topical antiblO s Id 
debriding enzymes) Jaco- h 
thoroughly covered the 
pathophyslOlc ! ar>-j nl I1g 
Implications Of thf>sP advance" 
Statlst'cal references and 
bibhographles have Deen extended 
and updated. 
I would have no hesitation in 
recommending this text to any nurse 
who is interested in helping to further 
the care of a burned patient. 

Discussing Death: A Guide to 
Death Education by Gretchen C. 
Mills, Raymond Reisler, Jr., Alice 
E. Robinson and Gretchen 
Vermilye, 140 pages, Illinois, 
ETC Publications, 1976. 
Approximate price: $5.50 
Reviewed by Larry SChruder, 
Instructor, Social Sciences, 
Algonquin College Nursmg 
Program, LOrrain Centre, 
Pembroke, Ontario. 

Social scientists, nursing 
educators, teachers and the public are 
becoming progressively more aware 
of the alarming paucity of information 
that humans possess regarding the 
topic of death, and the lack of 
awareness of their own feelings and 
attitudes about it. Discussing Death 
starts from this realization and does an 
admirable job at suggesting ways and 
means of correcting this situation. It 
joins a very small, select group of 
publications that centers on 
techniques for educating on the topic 
of death. 
The authors have presented their 
information in a style that is written 
primarily for teachers. It IS a resource 
book dealing with many aspects of the 
topic of death, but it is not structured 
as a death education course. The 
gUide IS separated into four age levels. 
5-6 years, 7-9 years, 1 0-12 
ears, and 
13-18 yeals, and presents material 
and experiences that would be most 
relevant at each level. The comments 
at the beginning of each age unit 
briefly summarize the typical 
conception of death held by the child 
at this developmental level. Each 
learning experience is organized into 
Opportunity, Objectives, Activities and 
Notes to Teacher. Complete 
bibllographlcal information follows 
'>ach of the four age levels Within 
each age unit, the learning 
expe, .ences are presented in a 
somewhat sequen!'-I fashIon from the 
basic to the more dIfficult concepts. 
The material dealing with the 
elementary school-age child occupies 
approximately one-half of the book 
and provides refreshing avenues for 
intrOducing the topic of death to this 
group. It has an excellent focus on 
feelings and would be a tremendous 
resource for an innovative elementary 
school teacher or a concerned parent. 

The remainder of the book 
examines techniques and themes for 
use with young adolescents. Although 
the feeling, experiential, and 
awareness measures are still 
incorporated, there is a greater 
inclusion of factual or informational 
material on the topic of death. Literary 
themes are used to direct the 
discussion of death issues. I had some 
diffIculty with such a strong literary 
emphasis, although an appendix 
section gives the wary (such as 
myself), some pointers on its efficient 
As an instructor in Death 
Education courses, I found this 
publication refreshing, with some 
innovative techniques and resources. 
I particularly enjoyed the 
feeling-centered approach of many of 
the ideas because I see this as being a 

crucial element of any death 
education endeavor. Although it is 
prirr>arily geared fo
 the elementary 
and secondary level, Discussing 
Death (with some selection and 
modification) would enrich any 
instructional work on the topic of death 
in the health and nursing area. It could 
serve as a valuable resource to those 
who see a need to educate in this 
area, but who question their courage, 
insight or ideas to implement a 
constructive program on their own. 

Did you know... 
The Alcoholic is a 38-page booklet 
examining some aspects of the 
alcoholic and his problems. Write to: 
The Ontario Blue Cross, 150 Ferrand 
Dnve, Don Mills, Ontario, M3C 1 H6. 


Black - Grey - Green - Blue - Red 





. . 

Combination Purchase 




Quebec Residents Add 8'70 Provincial Sales Tax 

Send cheque or money order to: 

10989 Masse 
Montreal-Nord, P.Q. 
H1G 4G5 



Antifungal and 
trichomonacidal agent 

INDICATIONS Canesten Cresm and Solution Topical 
treatment of the following dermal Infections tinea pedis 
tmea crUriS and tinea corpOriS due to T f"ubrum T menta- 
grophytes and Epldermophvton floccosum candidiasIs due 
to C alblcans tinea verSicolor due to MaiassezI3 furfur 
Csnesten Vagmal Tablets Treatment of vaginal candidiasIs 
and trichomoniasIS Canesten Vaginal Tablets may be used 
10 both pregnant and non-pregnant women as well as in 
women taking oral contraceptives (See Precautions) 
Thinly apply and gently massage suffiCient cream or solu- 
tion mto the affected and surroundmg skin areas tWice 
dally. in the morning and evening 
For vulVitiS Canes ten Crearr sho:.J'd be sop ed to the vulvs 
and as far as the anal region Fo bd'antt,s and pre",entlOn of 
vsgmal mfectlon or remfectlon b'll 
he oartner Canesten. 
Cream should be applied t !he!J ans pems 
Vagmal Tablets One tablet a day for SIX consecutive days 
USing the applicator. Insert one tablet deep mtravaglnally. 
preferably at bedtime In order to avoid treatment dunng 
menstruation. It IS suggested that treatment be started at 
least 6 days pnor to the anticipated menstrual penod 
duration of therapy vanes apd depends on the extent and 
localization of the disease Gpl1erally chnlcallmpro\lement 
with rebef of pruntus usuallY' c i. Vy hln tht f.:-st week of 
treatment Tinea infections reQLJ ... I(;"late'y 3 4 weeks 
of therapy while In candidiasIs ""eel . I ;llr'1e' IS often 
adequate If no clinical Impro"t: pr \led 8ftu 4 
weeks. the diagnosIs should bE" Ito'wec1 
If a cure IS not mycologically c'" hi med or In order that 
relapses may be prevented Ipartl( Jlarly In mycoses of the 
foot) treatment should as a rule b
 contmued 'or 2 weeks 
after all chnlcal symptoms have disappeared 
Vagmsl Tablets The six-day therapy may be repeated .. 
SPECIAL REMARKS Cream and Solul,on Added hyglen. 
ic measures are o. special Importance 10 the management 
of the often refractory fungal diseases of the 'oot To a\lold 
trapped mOisture. the feet - particularly between the toes 
- should be dned thoroughly after washlOg 
Onychomycoses oWing to their location and physiological 
factors. generally respond poorly to topical antimycotic 
therapy alone due to poor penetration mto horny substance 
Treatment with Canes ten may be conSidered 10 cases of 
paronychia and as ad,unctlve therapy In onychomycoses 
following extraction or ablation o. the nat! 
Vagmal Tablets Added hygienic measures such as tWice 
dady tub baths and avoidance o. tight underclothing IS 
highly recommended 
In the case o. chmcally significant tnchomonal Infection 
additional therapy with a systemic tnchomonacldal agent 
should be considered Such therapy IS essential for the 
treatment of vaglOal infections which may also mvol\le 
Bartholin.s glands and the urethra 
CONTRAINDICATIONS Except for possIble hyper- 
sensitivity Canes ten Solution Cream and Vagmal Tablets 
have no known contra indications 
PRECAUTIONS As with all topical agents skin senSItiza- 
tion may result Use of Canesten topIcal preparations should 
be discontinued should such reactions occur and approp- 
flate therapy instituted 
Canes ten Solution and Cream are not for ophthalmic use 
Canesten Vaginal Tablets are not 'or oral use 
Use 10 Pregnancy Although Intravaginal appbcatlon of 
clotnmazole has shown neghglble absorption from both 
normal and Inflamed human \laglnal mucosa. Canesten 
Vaginal Tablets should not be used 10 the first tnmester of 


t physIcian conSiders It essential to the 
The use of the supplied apphcator may be undesirable In 
some pregnant patients. and digital insertion of the tablets 
IS an alternative which should be considered 
SIDE EFFECTS Large scale cliOlcal tnals ha\le shown that 
Canesten IS very well tolerated after topical and vaginal 
Cream and Solution Erythema stmglng bhstering peehng. 
edema pruntus urtlcana. and generallfntatlon of the skin 
have been reported Infrequently 
Vsgmal Tablets Skin rash lower abdominal cramps shght 
unnary frequency and burning or irritation In the sexual 
partner have occurred rarely In no case was It necessary 
to discontinue treatment with Canesten Vaginal Tablets 
AVAILABILITY Canesten SolutIOn 1'-0 IS supphed In 20 ml 
plastic bottles. In carton Each ml contains 10 mg o. 
clotnmazole In a non-aqueous vehicle 
Csnesten Cream 1'-0 IS supphed In 20 g tubes 10 carton 
Each g containS 10 mg o. clotnmazole In vanishlOg cream 
Canesten Vaginal Tablets 100 mg are supplied 10 boxes 
containmg one strip of SIX tablets with plastic applicator and 
patient leaflet of lOst ructions 
REFERENCES 1 Lohmeyer. H . Postgrad Med J 50 
Suppl 78. 1974 2 Schnell. J 0 IbId p 79 3 Legal. 
H P . IbId. P 81 4 W,dholm 0 . IbId . P 85 5 Couch. 
man J M IbId.. P 93 6 H.gton B K . IbId. p 95 7 
Oates J K Ibid. p 99 8 Masterton. M B . et al . Curr 
Med Res Opln. 3 83 1975 9 Sawyer. P R . et al . 

. 1975 10 Postgrad Med J 50 Suppl . 
For further prescnblng information please consult the 
Canesten Product Monograph Or your Boehringer Ingelhelm 
FBA Pharmaceuticals Ltd. 
Distributed by: 
Boehringer Ingelhe,m (Canada) Ltd. 
2121 Trans Canada Highway 
Dorval, P.Q. H9P 1J3 


See advertlNment on page 17. 


The Canadian Nurse 

March 1977 

Libl il ll.-" lTI)(lllte 

Publications recently received in the Canadian 
Nurses' Association Library are available on loan- 
with the exception of items marked R - to CNA 
members, schools 01 nursing, and other institutions. 
Items marked R include reference and archive 
material that does not go out on loan. Theses. also 
R, are on Reserve and go out on Interlibrary Loan 
Requests for loans, maximum 3 at a tIme, 
should be made on a standard I nterlibrary Loan form 
or by letter giving author, title and item number in this 
If you wish to purchase a book, contact your 
local bookstore or the publisher. 

Books and documents 
1. Archer, Sarah, Ellen. Community health nursing; 
patterns and practice, by...and Ruth Fleshman. 
North Scituate, Ma., Duxbury Pr., c1975. 441 p. 
2. Association of Registered Nurses 01 
Newfoundland. Annual meeting programme and 
folio of reports 1976. St. John's, 1976. 112p. 
3. Auerbach, Stevanne. Child care: a 
comprehensive guide, edited by...with James A 
Rivaldo. New York, Human Sciences Press, c1976. 
4. Canadian Council on Hospital Accreditation. 
Guide to hospital accreditation. Toronto, 1977. 
5. Canadian Council on Social Development. 
Community multi-service centres; summary of 
recent developments in the delivery of personal 
health and social services and report of meeting on 
community multi-service centres. Vancouver 1976. 
Ottawa, c1976. 127p. 
6. Canadian Heart Foundation. Heart: facts & 
figures. Ottawa, 1976. 12p. 
7. Care for the injured child, by the Surgical Staff, 
the Hospital for Sick Children, Toronto. Baltimore, 
Md., Williams and Wilkins, c1975. 444p. 
8. Carter, Novia. Evaluating social development 
programs, bYn.with Brian Wharf. Ottawa, Canadian 
Council on Social Development, 1973. 161 p. 
9. Citizen evaluation of mental health services: a 
guidebook for accountability, by Val. D. 
MacMurray... et al. New York, Human Sciences 
Press, c1976. 124p. 
10. Le Conseil canadien de Développement social. 
Les centres communautaires de services 
polyvalents; résumé des développements récents 
de la prestation de services sociaux, sanitaires, 
personnels et rapport sur la réunion relative aux 
centres communautaires de services polyvalents, 
Vancouver 1976. Ottawa, c1976. 146p. 
11. Ethics and health policy, edited by Robert M. 
Veatch and Roy Branson Cambridge, Ma., 
Ballinger, c1976. 332p. 
12. Gartnel, Alan. The preparation of human 
service professionals. New York, Human Sciences 
Press, c1976. 272p. 
13. Morris, Terry. The story of MEDICO; a service of 
CARE. Baltimore. Md., Waverley Press, 1976. 62p. 
14. National League for Nursing. Council of 
Baccalaureate and Higher Degree Programs. 
Accountability and the open curriculum in 
baccalaureate nursing education. Papers 
presented at a February 1976 at 
Denver, Colorado, New York, 1976. 48p. (NLN 
Publication no. 15-1628) 

15.-. Dept. 01 Baccalaureate and Higher Degree 
Programs. Curriculum in graduate education in 
nursing: PI. 2. Components in the curriculum 
development process. New York, 1976. 64p. (NLN 
Publication No. 15-1632) 
16. O'Bryan, K.G. Les langues non officie/les; 
études sur Ie multiculturalisme au Canada, 
par...J.G. Reitz and O.M. Kuplowska. Ottawa, 
Ministre des Approvisionnements et Services 
Canada. c1976. 294p. 
17.-. Non-official languages; a study; a study in 
Canadian multi-cultu"sm, by... J.G. Reitz and O.M. 
Kuplowska. Ottawa, Minister of Supply and Services 
Canada, c1976. 275p. 
18. Organization for Economic Co-operation and 
Development. Reviews of national policies for 
education: Canada. Paris, 1976. 264p. 
19. Organisation mondiale de la Santé. Matériel de 
référence destiné aux auxiliaires sanitaires et à 
leurs enseignants. Genève, 1976. 97p. (OMS 
Publication Offset no. 28) 
20. Padilla, Geraldine V. Interacting with dying 
patients; an inter-hospital nursing research and 
nursing education project, by... Veronica E. Baker 
and Vikki A. Dolan. Duarte, Ca., City of Hope 
National Medical Center, 1975. 219p. 
21. Roche, Douglas. Justice not charity; a new 
global ethic for Canada. Toronto, McClelland and 
Stewart, c1976. 127p. 
22. Les toxicomanies autres que /'alcoolisme. 
Guide de diagnostic et de traitement, éd. 4, revue et 
mise à jour. Montréal, Corporation professionnelle 
des médecins du Québec, 1976. 54p. 
23. Victorian Order of Nurses for Canada. Report 
1975. Ottawa, 1976. 80p. 
24. World Health Organization. Reference material 
for health auxiliaries and their teachers. Geneva, 
1976. 97p. (WHO Offset Publication no. 28) 
25. Association canadienne contre Ja tubercuJose et 
les maladies respiratoires. Rapport 1975/76. 
Ottawa, 1976. 14p. 
26. Botterell, E.H. A model for the future care of 
acute spinal cord injuries, by... et al. Ottawa, Royal 
College of Physicians and Surgeons of Canada, 
1975. pp. 193-218. 
27. Canadian Tuberculosis and Respiratory 
Disease Association. Report 1975/76. Ottawa, 
1976. 14p. 
28. Day care: problems, process, prospects. edited 
by Donald L. Peters. New York, Human Sciences 
Press, c1975. pp. 135-222. 
29. Thomson, SA Common pediatric surgical 
lesions, by...and J.C. Fallis. Toronto, Hospital for 
Sick Children, Emergency Dept., 1976. 36p. 
30. National League for Nursing. Dept. of 
Baccalaureate and Higher Degree Programs. 
Baccalaureate programs accredited for public 
health nursing preparation 1976-77. New York, 
1976. 21p. (NLN Publication no. 15-1313) 
31.-. Dept. of Practical Nursing Programs. 
Practical nursing career; information about 
state-approved schools of practical nursing 
1976-77, New York, 1976. 37p. (NLN Publication no. 
Government documents 
32. Advisory Council on the Status of Women. Birth 
planning. Ottawa, 1976. 16p. (The Person Papers 
series no. 4) 


At Last... 

a Canadian supplier 
for nurses needs 
No 0001''''"9 about Customs - Noduty IOpøy. 


Your IOltlalsengraved onilny pur- 
chase (except walch) IState Initials 
desired on order form). 
While vinyl Pocket Saw-e,. w,th every 


Dual-Head Type m6 p reIl Y () J 
COlourS E .ceOl' , s()und 
"ansm'S510n adJustable "ght- I 
weIgh' bmaurðlS Has bOth A 
d,aohragm and old type bell 1/ 
w,'hNON-CHILLrmgCom- O . 
plere with spare d1aphrac n and 
earp,eees C.h
e r ørl b Je 
green s,lver iN ") t> a oIr: tubmg'. 
gold 9,ay $19.95 each 
Diaphragm Type As above 
) ,w,rnaul Dell Same large 
o aptJr 89m tor high sens"uf,'Y 
59 9S each 

Mercury Iype The ul/,mate 
ccuracy Fe js mlo lIght bur 
rugged me'al case Heavy duty 
Velcfoculf and 'nlla .., s.vslem 
559.00 e 


Aneroid Iype 
ugged""d ' 
dependable 1Ö year9uaran,ee 
01 accuracy 10 
3 mm W,th 
handsome zippered case ro f ....":... 
your pocket $24 95 each, .... 
 . _ 
NOTE: We service and stock 
spare par1s for above .tems. . 


 ,nstruments Exceptional 
I -.. - - 
 ,llummat,on powerfulmagnlly- 
..':- ... mg lens 3 standard size 
I "';:_ 
. s

:d S;;:t

; case 
lined w th sof, cloth a309 
e... 559.95 each fiI' 
""tI-.2 .,ps nd shIeld All melal 
$ 14 95 each 


A must for every Nurse 
Manulaclured of fmeSI steel and 

hed '
 san,'a 52 (9;("ne 
<700 5 53.23 
<702 7 53 T5 
Stainless Steel slra. ' 
.705 5 sharp blunt $285 each 
a7()6 5 sharp sharp $2 85 each 
.7104 IRIS SCISSorS 53 65 each 
F,nest Stamless Steel 5 long 
Kelly Forceps _724 Straight box-Io".... $4.69 each 
Kelly Forceps *125 Curved bOX-lOCk 54.69 each 
Thumb Dressmg 1I'74t Straight !errated $3.75 each 


A (]
p rr(]dO'
 d"rdC ,ve watch Full 
numbers on white lace Sweep 
second hand Chrome case stainless 
sleel back Jewelled movement 
bJaclt leat"e r Slla1). J yr gua1anleø 
0900 51850 
GOUld Medical Dlct,onary rtle standarCl relerence 
for the medIcal professions 
Ahugeboak -1828pages $, 
POCKETEDITION-964oages 511.95.ach. 
NURSES PENLIGHT Powerful beam lor 
'nrðmmd Ot, 0 ,nrodt e,e '-'''rome case w"h pocket 
clip $2 49 w"h ballefles 

THERMOMETERS CelS,us 'yoe m md,- 
vidual plasl, case $1 30 each $11.00 doz. 

your Comj: 1\1 I...." Id tor our catalogue 


I_ Quant 

Colour Price Amounl I 
or Size 
L 1==1 


33.-. Fringe benefits_ Ot1awa, 1976. 16p. (The 
Person Papels series no. 3) 
34.-. Regarding rape. Ottawa, 1976. 16p. (The 
Person Papers series no. 2) 
35. Bibliothèque nationale du Canada. Rapport 
annuel du directeur général, 1975/76_ Ottawa, 
Ministre des Approvisionnements et Services 
Canada, 1976. 61p. 
36. Le Conseil consultatif de la Situation de la 
Femme. Le cas du vio/_ Ot1awa, 1976. 16p. 
(Dossiers Femmes no. 2) 
37_-_ Planiftcation des naissances. Ottawa, 1976_ 
16p. (Dossiers Femmes no. 4.) 
38. National library of Canada. Report of the 
natIonal librarian 1975/76_ Ot1awa, Minister of 
Supply and Services Canada, 1976. 61p. 
39- Santé et Bien-être social Canada. Protection de 
la Santé_ Les malades liées à fusage du tabac au 
Canada: les ten dances de la mortalite cancer du 
poumon. Ot1awa, 1976_ 16p. (Son Rapport 
technique no_ 3) 
40. Statistics Canada. Hospital statistics Vo/_ 1_ 
Beds, services, personnel, 1973. Ot1awa, 1976_ 
293p. R 
41.-. Hospital statistics_ Vol. 2_ Expenditures, 
revenues, balance sheets, 1973. Ottawa, 1976. 
142p. R 
42.-. Hospital statistics. VoL 3. Indicators, 1973_ 
Ot1awa, 1975_ 102p. R 
43. Statistique Canada. La statistique hospitaliére. 
Vol. 1_ Vts, services, personnel, 1973_ Ot1awa, 
1976. 142p.R 
44.-. Lastatistique hospitaliére Vo/_ 2_ Dépenses, 
rev en us, bilans hospitaliers, 1973. Ot1awa, 1976. 
293p. R 
45_-. La statistique hospitaliére. Vo/_ 3. 
Indicateurs, 1973. Ot1awa, 1975. 102p. R 
Nova Scotia 
46. Council of Health. Committee on Professional 
licensure. Report. Halifax, 1976. 69p. 
47. Ministry 01 Health. The clinical specialists in 
psychiatric and community mental health nursing in 
Ontario. Toronto, 1976. 12p. 
48_ Ministry of Labour. Research Branch_ O.H.I.P., 
major medical, prescription and dental plans in 
Ontario col/ective agreements. Toronto, 1976. 15p. 
(Bargaining information series, no. 16) 
49.-_ Paid vacations and paid holidays in Ontario 
col/ective agreements. Toronto, 1976_ 23p. 
(Bargaining Information series, no. 15) 
50.-. Reporting, cal/-back and stand-by pay,- shift, 
Saturday and Sunday premiums, and work 
clothing, safety equipment and tool allowances In 
Ontario collective bargaining agreements. Toronto, 
1976. 12p. (Bargaining information series, no. 11) 
51. Ministère des Affaires sociales_ Cours sur la 
grossesse et /'accouchement; mémoire d'intention 
sur /'implantation progressive du programme. 
Québec, 1975_ 127p_ 
52_-. Orientations généra/es en santé 
communautaire_ Québec, 1973. 106p_ 
53_-. Comité d'étude sur la réadaptalion des 
enfants et adolescents placés en centres d'accueil. 
Rapport. Québec, 1975_ 173p. 
54. Régie de I assurance-maladie. Statistiques 
annuel/es, 1975_ Québec, 1976. 182p. 
Studies deposited in CNA Repository Collection 
55_ Cunningham, Rosella. An analysis of the 
application of the concept family-centered care in 
public health nursing visits. Toronto, Faculty of 
Nursing, University of Toronto, 1976_ 68p_ R 
56. Perron, Marie-Reine, Sister. Report on survey_ 
A project undertaken at a large hospitallocated in a 
metropolitan city in Ontario, by Sister 
Sainte-Honorine. London, Ont. 1970. 76p. (Thesis 
(M_ScN) - Westem Ontano) R 



........ I , ' I 

I , " 


Use it to find a better 
. . 
career .n nursing. 

Job-hunting? Here s "here to start! 
The ne\\ 197' edition of Nursing Op- 
portunities'"' is a unique 8 x 11" gUide to 
professional employment. It tells you 
about hundreds ot hospitals and insti- 
tutiOns in the US _ _ _ with positions 
open for registered nurses. 
Here is the up-to-date job in tor mati on 
you want and need_ About hospital 
sizes, tacilities, and locations. Affilia- 
tions. Salary policies. Benefits like in- 
surance, pension plans, education, \ a- 
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· Expert ad\ ice on how to select the 
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· Free "Action" Cards-simply fill in 
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· Geographical inde
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. Questions to ask on )our interviews; 
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Cost tor the complete Nursing Oppor- 
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An RN Publication 

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\\e tw od, "'i J. 0-6-5 u 
Please send _ _ copies of 197- ' 
Opportunities @ S4.50 each. 
Enclosed find S check Or mone) 





Po' al 


The Canadian N uree 

March 1977 

("I.Issi f-i(-(I 
. \(I",pl-t iSelllPlltS 

British Columbia 

Faculty - Naw positions (4) In 2-year post.oasic baccalaureate 
program In Victoria. B.C.. Canada Generahst In focus, cltnlcal em- 
phasis on gerontology In communrty and supportIVe e.tended care 
uMs. Publoc Health nursing and Independent study provIde opportu- 
nity to wor\< closely WIth highly-qualllted and motIvated R.N. students. 
Teaching crealtVlty and research are strongly endorsed. Master's 
degree. teachIng and recent clinical e.penence In gerontology/med.- 
surg.lpsychology/rehabllitatlon preferred. Salanes andlnnge bene- 

ts competitive; an equal opportUnity employer for qualolled persons. 
Pos,\\Ons avadable NOW. Contact; Or. lsabal MacRae, Dlreclor, 
School 01 NursIng, UnIVersIty 01 Vlctona, VIctoria, Bnltsh ColumbIa, 
V8W 2Y2. 

Operstlng Nur.. requored for an 87 -bed acute care hospital In Nor- 
them B.C. Resldance accommodations available. RNABC policies in 
effect. Apply 10: Diraclor 01 NurSing, M,lls Memonal Hospital, Terraca, 
Bntlsh Columbia, V8G 2W7. 

Ganeral Duty Nurses for modarn 35-bed hospilallocated in south- 
ern B.C. s Boundary Area with ,xcellent recreation faalitlÐS. Salary 
and personnal polioes In aCCOroance wrih RNAt3C L;omfortablè 
Nurses home. Apply DIrector 01 NursIng. Boundary Hospital, Grand 
For\<s. Bntlsh Columbia, VOH 1HO. 

Experienced General Duty Nuree for modam 10.oed hospotal situa- 
ted on the baautnul West Coast of Vancouver Island. AccommodatIon 
$100.00 per month. Apply: Administrator, Tahsls Hospital. Box 39B, 
TahSis, British Columbia, VOP 1XO. 


Director 01 Nursing. Applications Invited lor the posriion 01 Director 01 
Nursing lor 23.oed. gen. hospital (accredited). Prefarence gIven to 
applicants with lorrnal administraltve education and experiance. Sa- 
lary In Iona WIth qualolications and MHSC approval. For datads apply to; 
AdmInistrator. Shoal Lake Distnct Hospital, Shoal Laka. Manl1Oba, 
ROJ 1Z0. Phona: 759-2336. 

New Brunswick 

Instructors requred fOr two yaar Indapendent DIploma Program In 
NursIng. Enrollment 230 students. Faculty requred Juna-July 1977. 
Contact: MIss Anna O. Thome, Director, Saint John School 01 Nur- 
sIng, P. O. Box 187. SaInt John, New BrunswIck, E2L 3X8. 


Registered Nurse requl'ed lar CO-ad chilclren s summtlt' camp in the 
Laurentians (sevanty mdes north 01 Montreal) from lata Juna until late 
August 1977. Call (514) 487-5177 or wrile: Camp MaroMae, 5901 
Fleet Road, Hampstead. Montreal, Quebec, H3X 1 G9. 

Nurses for Children's Summer Cllmps in Quebec. Our member 
camps are located In the Laurentian Mountains and Eastern Town- 
ships. within 100 mile radIus of Montreal. All camps are accredited 
members 01 the Quebec Camping Association. Apply to: Quebec 
Camping AssOCIatIon. 2233 Bel9rave Avenue. Montreal. Quebec, 
H4A 2L9. or phone 489-1541 


Director 01 Nursing requred tor a 1 O.oed general hos
ltal 35 mIles 
N. W. 01 Saskatoon. Salary and personnel poliCIes according to S. u. N. 
contract. Accommodalton avaIlable in reSIdence. Apply: Director 01 
Nursin9, Borden Union Hospilal. Borden. Saskatchewan. SOK ONO. 

University 01 Saskatchewan. Term and regular appointments n 
Matemal-Chdd. pnmary Care, Communrty and Mental Health Nur- 
SIng. To teach In four-year basIc and three-year pæ!-diploma pro- 
grams and Implement revised curriculum. Maste'-s or higher degree 
and expenence In clonlcal 
eld for appoontment at professonal ranks; 
Baccalaureate degree and experience for appointment as leeturer. 
StartIng elata; Summer 1977. Contact; Dean, College 01 Nursing, 
Umllersrty of Saskatchewan, Saskatoon, Saskatchewan, S7N OWO. 

United States 

Registered Nur..s - Dunhlll, wrih 200 ol
ces In the U.S.A., has 
e"otlng career opportunriles lor both new grads and experienced 
R.N.s. Send your resumé to: Dunhlll Personnel Consunants, No. 805 
Empire Buoldlng, Edmonton, Alberta, TSJ 1 V9. Fees are paid by 

Regletered Nu...s - Hurtey Medical Centtit' is a well equopped, 
modtlt'n, 600-bed teachIng hospItal oHtIt'ing complete and specialized 
services lor the restoration and preservetlon of the communlty"s 
health. tt also offers onentatlon. In.servlce and continuing ed.Jcation 
for employees. n is involved In a building program to provide beller 
surroundIngs lor patients and employees. We have Immediate ope- 
nings for registered nurses In such speCialty unts as Cardia-Vascular. 
Operating Rooms. Nurseries, and General Medical.Surgical areas. 
Hurley Medical Center has excellent salary and fringe benefIts. Be. 
come a part 01 our progressIve and well quahlied work lorce Today. 
Apply: Nursing Department. Mr. Garry Viele. Associate Dorector 01 
Nursing, Hurley Medical Center, Flnt, MIchIgan 48502. Telephone 
(313) 766-0386. - 

Nursee - RNe -Immediate Openings In Florlde - Arllensae- 
Calltornla - ff you are e.penenced or a racent Graduate Nurse we 
can olfer you posilions with excellent salanes 01 up to $1160 per 
month plus all benefits. Not oriy are there ro lees to you whatsoever lar 
placing you, but we also prOVlde complete Visa and lJcensure assis- 
tance at also no cost to you. Write immediately for our applocation ellen 
n there are other areas of the U.S. thai you are interested .n. We wIll 
call you upon receipt 01 your applicatIon in order to arrange for hospital 
Interviews. Windsor Employment Agency Inc., PO. Box 1133, Great 
Neck, New Yor\< 11023. (516-487-281B). 

Hospital Affiliates 
International Inc. 



Hospital Affiliates International, the leader 
in the field of hospital management, has 
over 70 hospitals in operation or under 
construction in 23 States. 
On-going opportunities exist for Canadian 
citizens who have graduated from an 
accredited Canadian School of Nursing. 
Openings exist in all clinical areas. 
If you are considering working in the 
United States, and have an interest in 
associating yourself with one of our 
hospitals, please contact our Canadian 
representative who will be pleased to 
discuss your specific needs. All enquiries 
will be treated in confidence and should 
be directed to: 

365 Evans Ave., Toronto M8Z 1K2 

Nursing Supervisor 

Nursing Supervisor 
required for an active 
treatment accredited 

For Information apply to: 

Director of Nursing 
Lloydminster Hospital 
4611 - 48 Avenue 
Lloydminster, Saskatchewan 
S9V OZ5 

or Phone: 825-2211 

For All 
Classified Advertising 
$15.00 for 6 lines or less 
$2.50 for each additional line 
Rates for display 
advertisements on request 

Closing date for copy and 
cancellation is 6 weeks prior to 1 st 
day of publication month. 

The Canadian Nurses Association 
does not review the personnel 
policies of the hospitals and agencies 
advertising in the Journal. For 
authentic information, prospective 
applicants should apply to the 
Registered Nurses' Association of 
the Province in which they are 
interested in working. 

Address correspondence to: 

The Canadian Nurse 

50 The Driveway 
Ottawa, Ontario 
K2P 1 E2 


I - 

Tn. ç NW" ..rçn n,,1 


O.R. Nurse? 
Switzerland needs you! 

............. ............. 



You've been promising yourself a trip to Europe forquite 
some time now, haven't you? So why not come with us 
to work and play in Switzerland, the very heart of 
Europe, you can travel all you want Or ski all year round 
And you'll earn the highest salaries in Europe to go with 
it - up to SF2,700 (approx. $C1, 102.95) plus 4 weeks 
holiday and 8 public holidays. 

This individual will be di rectly involved with the management of 
nursing care of the high risk neonate in a family centered 
maternity care unit of a University Teaching Hospital. 

We can offer you many interesting jobs in various towns 
throughout French-speaking Switzerland. Contracts are 
for one year - renewable if you wish. We ask for a fair 
knowledge of French - an intensive 1 month course can 
be arranged in London if you need to brush up a little. So 
if you have at least one year's experience as an O.R. 
nurse, write to us. We'll arrange your work permit and 
trip for you. You won't regret it! 
For further Information write to:- 

The successful candidate will have a BScN with a minimum of 
two years working experience in neonatal care. A completed 
University Program in Nursing Service Administration would 
also be preferred. 

Qualified applicants are Invited to reply sendIng a 
complete reaume and aalary expectations to: 
Personnel Department 
Foothilla Hospital 
1403 - 29 Street N.W. 
Calgary, Alberta 
T2N 2T9 

Miss Susan Bentley, SRN 
BNA International 
Trafalgar House 
11 Waterloo Place 
London SW1 Y 4AU 


1.Clinical Nursing Head for Intensive 
Care Services 

2.lnservice Instructor - Maternal 
and Child Health 

Clinical Areas Include: 
a) Intensive Care Medicine 
b) Coronary Care 
c) Cardio Vascular Thorocic Surgical Area 
(Cardiac Surgery) 
d) Intensive Care Surgery 

The successful applicant will work in conjunction with the 
Nursing Coordinator and Clinical Nursing Head in the planning 
and implementation of Orientation of New Staff, Continuing 
Education, Specific In-Service and Skill Training Sessions for 
all units in the perinatology department which consists of: 

The successful applicant will have the opportunity to provide 
nurSing leadership and functioning clinically in: 

. Intensive and Intermediate Care Nurseries 
. Labour and Delivery (including fetal Intensive Care) 
. Ante Partum - Post Partum 

. Cardiac Surgery Team 
. Renal Team 
. Cardiology Team 
. Neuro-Surgery Team 
. Respiratory Team 


a) a minimum of 2 years perinatology experience 
b) a Baccalaureate degree 
c) teaching experience 


a) Advanced academic preparation 
b) 5 years clinical experience preferred 
c) management experience 

Eligibility for registration with the Manitoba Association of 
Registered Nurses is necessary for the above two positions 

Position Open: May, 1977 

Please apply to: 
Mrs. Phyllis McGrath 
Director of Nursing 
S1. Boniface General Hospital 
409 Tache Avenue 
Winnipeg, Manitoba R2H 2A6 


Extension Course in Nursing Unit 

Applications are invited for the extension course in Nursing Unit 
Administration, a program to help the head nurse, supervisor or 
director of nursing up-date his or her management skills. Candidates 
will be registered nurses or registered psychiatric nurses employed in 
management positions on a full-time basis. 

The program provides a seven month period of home study with two 
five day intramural sessions, one preceding and one following the 
home study. For the 1977-78 class the initial intramural sessions will 
be held regionally as follows: 

Vancouver August 22 -26 
St. John's (Nlld.) August 29 - September 2 
Winnipeg August 29 - September 2 
Montreal (French) August 29 - September 2 
Hamilton September 12 -16 
O<<awa September 12 -16 
Toronto September 19 -23 

Early application is advised. Applications will be accepted until May 
16, 1977, if places are still available atthattime. After acceptance, the 
tuition fee of $275.00 is payable on or before July 1, 1977. 

The program is co-sponsored by the Canadian Nurses Association 
and the Canadian Hospital Association and is available in French or in 

For additional information and application forms write to: 
English Program: 
Extension Course in Nursing Unit Administration 
25 Imperial Street 
Toronto, Ontario 
MSP 1C1 

Dalhousie University 
School of Nursing 


Dalhousie University School of Nursing invites 
applications for faculty positions in a rapidly expanding 
graduate programme which offers clinical specialties in 
Medical-Surgical and Community Health Nursing. 
Faculty should have post-masters or doctoral 
preparation with experience in clinical nursing and 
nursing education. Rank and salary for positions 
commensurate with qualifications and experience, and 
in accord with the salary schedule of Dalhousie 

Applications and further information may be 
obtained from: 
Dr. Margaret Scott Wright 
Professor and Director 
School of Nursing 
Dalhousie University 
Halifax, Nova Scotia 
B3H 4H7 

The Can""an H.... March 1977 


Join us at one of the three Hospitals of the South Saskatchewan 
Hospital Centre, Regina, Saskatchewan 

. Provincial Capital 
. University Centre 

Nursing Areas: 
. Chronic Care 
. Coronary Care 
. Emergency 
. Intensive Care 
e Matemity 
. Medicine 
. Nuclear Medicine 
. Nursery 
e Operating/Recovery Room 
e Orthopaedics 
. Paediatrics 
. Plastics 
e Rehabilitallon 
. Research 
. Surgery 
. Teaching 
. Urology 

. II 11111_ 
J: II .........,.' 
, 11I1I1.:
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Interested appliçmts should be eligible for registration in 

Apply to: 

Personnel Department 
Pasqua Hospital 
4101 Dewdney Avenue 
Regina, Saskatchewan 
S4T 1 AS 

Western Memorial Hospital 
Corner Brook, Newfoundland 



For a 350 bed. fully accredited, acute treatment, Regional General 
Hospital serving a population of approximately 100,000, scenic city 
with modem shopping. housing and education facilities. 

Salary Scale: $10.800.00 - $13,165.00 per annum. 
Service Credits Recognized. 
Shift Differential - $1.50 per shift. 
Charge Nurse - $3.00 per shift. 
Uniform Allowance - $90.00 per year. 

Educational Differential - Extra three steps on salary scale for 
B.N. Degree. four steps for 
Masters Degree. 
Annual vacation - Twenty days. 

Statutory Holidays - Nine plus Birthday. 

Residence accommodation for $35.00 per month. 
Transportation available. 
Applicants please apply to: 
(Mrs.) Shirley M. Dunphy 
Director of Personnel 
Western Memorial Regional Hospital 
Corner Brook, Newfoundland 
A2H 6J7 


The Department of Health, Psychiatric 
Services Branch, Saskatchewan 
Hospital, North Battleford, has openings 
for full-time and part-time nurses. Duties 
involve planning the patient care program 
in a stimulating atmosphere of a large 
progressive hospital. Programs range 
from acute psychiatric nursing, long term 
and rehabilitation to psycho-geriatric 
The successful applicants will have 
graduated from an approved school of 
psychiatric or general nursing. 
$10,092 - $11,712- 
Graduate Nurse 
$11,256 - $13,068- 
Nurse 1 
(Saskatchewan registration) 
Competition Number: 
604111 -6-282 
Cloelng Dete: 
As soon as possible 
Forfurther information, please contact the 
Supervisor of Personnel, Saskatchewan 
Hospital, Box 34, North Battleford, 
Saskatchewan, S9A 2XB. 
The salaries listed are under review with 
an effective date of October 1, 1976 for 
any adjustment. 
Forward your application forms and/or 
resumes to the Public Service 
Commission, 1820 Albert Street, Regina, 
Saskatchewan, S4P 2S8, quoting 
position, department and competition 

Faculty members will be required for 
positions in expanding four-year basic 
and two-year post-R.N. baccalaureate 
programs. Applicants should have 
graduate education and experience in a 
clinical area and/or in curriculum 
development or research. 
Short-term or visiting appointments may 
also be available in some areas to replace 
staff on leave. 
Salary and rank commensurate with 
qualifications and experience, in accord 
wIth University policies. 
Positions are open to male and female 
Please make further inquiries, or 
submit application and curriculum 
vitae to: 
Amy E. Zelmer, Ph. D. 
Faculty of Nursing 
The University of Alberta 
Edmonton, Alberta 
T6G 2G3 

Prince Henry's Hospital, 
St. Kllda Road, Melbourne, Victoria, Australia 


Due to our expanding educational programme for student nurses, we 
have a number of vacancies for 


In critical care areas and general medical and surgical wards. Qualified 
Nurse Teachers are also required for our School of Nursing. 
SALARY: From $A159.50 to $A 1 87.10 per 40 hour week for general 
nurses and $A224.90 to $A236.90 for qualified teachers. Penalty rates 
attached to night and weekend duty. 
VACATION LEAVE is 6 weeks per annum. 
BOARD AND RESIDENCE is available, if required, in our modern 
nurses' home. at a cost of $A 18.00 per week. 
Economy class air fare to Melbourne will be refunded upon 
commencement of duty and in return for an agreement to work at the 
hospital for 12 months from date of commencement. 
QUALIFICA TIONS: Applicants must be registrable with the Victorian 
Nursing Council and details in this connection are available from the 
Australian Embassy or Consulate in Ottawa, Montreal. Toronto or 
Prince Henry's, a 409 bed acute general teaching hospital, is 
conveniently situated on one of Melbourne's attractive thoroughfares 
adjacent to extensive park lands. It is within 10 minutes walking distance 
from the heart of the city and is well served by public transport. 
Interested nurses, who must have had at least 12 months post graduate 
experience should write to the Director of Nursing Services (MIss D. J. 
Taylor), Prince Henry's Hospital, St. Kilda Road, Melbourne, 3004, 
Australia, giving details of age. qualifications and nursing experience. 
in time to reach Miss Taylor before 14th April. 1977 on which date she 
will depart for overseas to conduct personal interviews in Toronto (19th 
- 22nd April) and Ottawa (25th - 29th April). 6508 


(a) Nurse Educator 
(b) Theatre Supervisor 

Why not travel? This 220-bed training 
school for General and Auxiliary Nurses is 
set in most pleasant surroundings. 

AccommodatIon available if reqLired 
Uniforms provided. 

Salary Range: 

Nurse Educator 
-SA9.533 - SA10,782 per annum 
Theatre Supervisor 
- SA10.574 -SA10.782 per annum. 

Diploma and Certificate Allowances 

For further information, contact: 

Miss G. Bingham 
Lady Superintendent of Nursing 
Mersey General Hospital 
Latrobe, Tasmania, Australia 


The UnIVersity of Windsor, School of 
Nursing invites applications lor faculty 
appointments for the academic year 

The School is seeking individuals with 
expertise in nursing research, community 
health nursing, psychiatric nursing and 
maternal-child nursing who are interested 
in the challenge of implementing new 
Integrated curlicula in the generic and 
post-basic baccalaureate programmes. 

Appointments effective July 1, 1977. 

Master's Degree in Nursing 
Clinical Wor\< Experience 
Teaching Experience (desirable) 
Salary and Rank commensurate with 

For further information contact: 

Mrs. A. Temple 
Director, School of Nursing 
University of Windsor 
Windsor, Ontario, N9B 3P4. 

Foothills Hospital, Calgary, Red Deer College School of Nursing 
Alberta invites applications for faculty Assistant Director 
Advanced Neurological- positions in the Diploma Nursing required in a 2 year English 
Neurosurgical Nursing Program. language diploma Nursing 
for Graduate Nurses Preference given to applicants with program 
A five month clinical and academic advanced preparation and clinical Qualifications: 
proglam offered by The Department of specialization, who have proven Master's degree in Nursing Education, 
Nursing Service and The Division of ability in the teaching of Nursing. preferred, with experience in Nursing 
Neurosurgery (Department of Surgery) Education Administration and teaching 
Beginning: March, September Positions available August 1, 1977. and at least one year in a Nursing Service 
Umited to 8 participants Please forward application, Eligible for registration in New Brunswick. 
Applications now being accepted comprehensive curriculum vitae and Apply to: 
references to: 
For further information, please write Harriett Hayes 
to: Dr. Gerald O. Kelly Director 
Co-ordinator of In-service Education Academic Dean The Miss A.J. MacMaster 
Foothills Hospital Red Deer College School of Nursing 
140329 St. N.W. Calgary, Alberta Box 5005 Postal Station A, Box 2636, 
T2N 2T9 Red Deer, Alberta, Canada Moncton, N.B. 
T4N 5H5 E1C 8H7 
BA Clinical Specialist Port Saunders Hospital 
Nursing requires one Registered 
DEPARTMENT OF We require the services of an articulate, Nurse commencing May 
HEALTH AND SOCIAL DEVELOPMENT dynamic nurse with a Master's Degree 1977 through to October 
The School of Nursing and a Major in Medical-Surgical nursing 1977. 
Selkirk Mental Health Centre We are a 300 bed Hospital Complex on 
is offering a Applicants must be registered or 
Post - Basic Course in the verge of a major expansion. We are eligible for registration with the 
PSYCHIATRIC NURSING for close to fine recreational and cultural Association of Registered Nurses of 
Registered Nurses currently licensed In The nurse in this position will work closely Newfoundland. 
Manitoba or eligible to be so licensed. with our Medical Staff, Administrative Salary is on the scale of $9,963 to 
The course is of nine months duration Staff and Staff Nurses to further develop $12,282. 
September through May and includes patient centered projects. The salary and Living-in accommodations available 
theory and clinical experience In hospitals benefits are based on the qualifications for single applicants. 
and community agencies, as well as four and experience of the applicant. 
weeks nursing of the mentally retarded. For further information about this Applications should be addressed to: 
Successful completion of the program leads opportunity, please forward a Mrs. Madge Pike 
to eligibility for licensure with the R.P.NAM. complete resume to: Director of Nursing 
For further information please write no Director of Personnel Port Saunders Hospital 
later than June 15/77 to: Director of Red Deer General Hospital Port Saunders, Newfoundland 
Nursing Education, School of Nursing, Red Deer, Alberta AOK 4HO 
I Box 9600, Selkirk, Manitoba R1A 2B5 T4N 4E7 



Phone: (416)-449-5883 OR WRITE TO: 


Head Nurse 

Head Nurse 

The Position: 
Directing an active 40 bed surgical unit 
with opportunity for future advancement. 
The Person: 
Should have a Baccalaureate degree with 
a clinical specialty and/or administrative 
The Hospital: 
Central Alberta location in an expanding 
regional hospital. 
The City: 
30,000 population half way between 
Edmonton and Calgary and close to the 
best in skiing and recreation centres. 

with preparation and/or 
demonstrative competence in 
Psychiatric Nursing and 
Management functions, required for 
Head Nurse appointment. To be 
responsible for participation in the 
organization, initiation, and the 
management of a New Psychiatric 
In-patient Unit. 

Please apply, forwarding 
complete resume to: 
Director of Personnel 
Stratford General Hospital 
Stratford, Ontario 
N5A 2Y6. 

Please send complete resume to: 
Director of Personnel 
Red Deer General Hospital 
Red Deer, Alberta 
T 4N 4E7 





?l it! 
-, . - - j- \ . 

. ,- -




\ . 


-..;;;..."" - -:.- Tf:: --=-=- 
- . 


can go a long way 
. . . to the Canadian North in fact! 
Canada's Indian and Eskimo peoples in the North 
need your help. Particularly if you are a Community 
Health Nurse (with public health preparation) who 
can carry more than the usual burden of responsi- 
bility. Hospital Nurses are needed too... there are 
never enough to go around 
And challenge isn't all you" get either - becaus'" 
there are educational opportunities such as in- 
service training and some financial support for 
educational studies, 
For further information on Nursing opportunities in 
Canada's Northern Health Service, please write to: 

MedIcal Services Branch I 
Department of National Health and Welfare 
Ottawa.Ontarro K1A OL3 

I NalT'''' 
I Ac 
I City 
I . . Health and Well".., Sante et B'en-etre social 
Canada Canada 


Clinical Co-ordinator 
Surgical Specialities 

Responsible to the Assistant Director of 
Nursing for planning, co-ordinating and 
supervising patient care. 

Applicants should be university graduates 
with Ontario registration and with a minimum 
2 years experience at the Head Nurse level. 

General Hospital 
O n i vers i ty 
Teaching Hospital 

. located in heart of downtown Toronto 
. within walking distance of accommodation 
. subway stop adjacent to Hospital 
. excellent benefits and recreational facilities 

apply to Personnel Office 

work .. 
...join rLlS6 




If you are a medical professional, we need you. 
CUSO IS lOOking lor people who ale willmg to work 
overseas sharing their skills with those who need 
them most. CUSO workers usually combine practical 
application of their skills with training duties But In 
the end. they learn as much as they teach 

We need: 

Two year contracts are standard. Salary generally 
equals a local workel's m a similar job. Couples and 
families are eligible. but families with pre-school 
children are easier to place. CUSO pays for life 
insurance. health and travel expenses and an 
allowance for re-settlement in Canada 

CONTACT: CUSO ReCluitment: 13 
151 Slater Street 
Ottawa, Ontario K1P 5H5 


Director, Public Health Nursinl 

Applications are invited for the position of Director, 
Public Health Nursing in this Health Unit serving 
110,000 population. 


A Master's Degree is preferred, consideration given to a 
Bachelor's Degree. 
Applicants must have experience In administration and 

Apply in writing to: 
Dr. Lucy M. C. Duncan 
Medical Officer of Health 
The Lambton Health Unit 
333 George Street 
Sarnia, Ontario 
NTT 4P5 

Judy Hill Memorial Scholarship 
Applications are being received for this annual Scholarship, details of 
which are as follows: 
Value Up to $3.500.00 
Purpose To fund post-graduate nursing training (with special 
emphasis on midwifery and nurse practitioner training) for a period of 
up to one year commencing July 1st. 1977. 
Tenable In Canada, the United Kingdom. Australia, and New 
Applicants should possess the following qualifications: 
. Fluency in English; 
. . R.N. Diploma, or eqUivalent: 
. A desire to work for the Government of Canada or one of its 
Provinces at a fly-in nursing station in a remote area of Northern 
Canada for a minimum peliod of one year following completion of 
the scholarship year. (Details of this work will be forwarded on 
And should submit: 
. A resume of their academic and nursing career to date; 
. Copies of the educational qualifications submitted on entry to 
nursing school; 
. Verification of their R.N. Diploma. or equivalent; 
. Their proposed course of study; 
. Acceptanæs and/or preferences for plaæ of study; 
. Two character reference letters. 
To: Chairman. The Board of Trustees. 
Judy Hill Memonal Fund, 
829 Centennial Building, 
Edmonton, Alberta. 

By: May 1st, 1977. 
. The Scholarship IS contingent on the successful applicant S being registrable Dy a 
nursing assooallon In one of the Canadian provinces and meeting current Canadian 
Immigration requirements for landed Immigrant status_ A successful applIcant from 
outside Canada will be assisted by the Trustees In meeting these reqUirements 

In. .......IAII... nUl" _''-11 ."". I 

Index to 
March 1977 

Abbott Laboratories 

Cover 4 

Barco of California 


Jean-Luc Belanger Inc. 


Boehringer Ingelhelm (Canada) Ltd. 
The Canadian Nurse's Cap Reg'd 

17, 56 


The Clinic Shoemakers 


Connaught Laboratories Limited * 
Designer's Choice 

42, 43 

Cover 2 

Equity Medical Supply Company 
Health Care Services Upjohn Limited 
Hollister Limited 




Frank W. Horner Limited 


Kendall Canada 


The C.V. Mosby Company Limited 

8, 9, 10, 11 

Nursing Opportunities 


Reeves Company 
W.B. Saunders Company Canada Limited 



Standard Brands Canada Limited 


Stiefel Laboratories (Canada) Limited 

Cover 3 

* CORRECTION NOTICE: The pages of thIS ad were reversed in the January 

Gerry Kavanaugh 
The Canadian Nurse 
50 The Driveway 
Ottawa. Ontario K2P 1 E2 

Advertising Representatives 
Richard P. Wilson 
219 East Lancaster Avenue 
Ardmore. Penna. 19003 
Telephone: (215) 649-1497 

Gordon Tiffin 
2 Tremont Crescent 
Don Mills. Ontario M38 281 
Telephone; (416) 444-4731 

Member of Canadian 
Circulations Audit Board Inc. 


BenoxylTMLotion 20% 
proven effective 
in treatment of cutaneous ulcers 

'Co. '\ 

Left : ulcer of right greater trochanter, 14 cm in diameter, with 
undercutting of superior border to 3 cm. Right: full healing after 
8 months therapy with benzoyl peroxide. 

Benzoyl peroxide. a powerful organic 
oxidizing agent, was applied topically 
according to a carefully developed 
technique to cutaneous ulcers of 
different types. The healing time was 
shortened greatly by the rapid 
development of healthy. granulation 
tissue and the quick ingrowth of 

Exceptionally large pressure ulcers 
with deep cavities. undercut edges 
and sinus tracts were successfully 
treated. as were stasis ulcers of long 
duration resistant to all other therapy 
There were only 13 
treatment failures 
among the 133 .. 

Available only from Stiefel 
I f!!!
TM trademark 
Montreal, Canada H4R 1E1 

0IN;1: -.- . 


: ' ,"-, WE: T.-
I of cutBneous ulcers WIth benzoyf peroxide. Can Mad 
AssocJ 115:1101,1978 


,. . 






" J 
\. .
" I 

\ .. 
.. ....- . 


I J .. 




the original and universally accepted 
winged Infusion set. 

.. . 


.- @ @.......".... 
.... -II@ 

April 1977 

935 971 
S EO "'CC"E 

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Designer's Choice 
One of Canada's truly greats in fashion design 
A. Style No. 8293 - Tunic Dress. Sizes: 6-16 
Royale Linen 100% textured polyester warp knit. White, Blue: about $33.00 
B. Style No. 8237 - Wrap Dress. Sizes: 6-16 
Royale Linen 100% textured polyester warp knit. White, Mint: about $28.00 

Available at leading department stores and specialty shops across Canada. 

We're out to 
and wow you! 

Wow is right. What winning looks. 
We're out to woo you softly. Just 
because you're working in a uni- 
form world doesn't mean you 
can't be right in step with 
fashion. So when we 
heard the newest 
trends called 
for uncluttered, 
lines, we came up 
with three new looks 
that couldn't be fresher or more 
fashionable. But we also know that 
no matter how pretty our faces 
are, what you really love us for is 
our beautiful bodies. Contoured 
to cuddle, shaped to support. 
light enough to lighten your 
longest days on duty. 
So deep down where it G\-\
counts, we haven't 'l'IOw IS RI 
changed a bit. 
The face is 
as new as to- 
morrow. But 
the body is as 
comfortable as 
an old shoe. 
Ask to see Day-Lites F. 
And step into tomorrow. 








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(:,0 þ..HEAD AND woo ME! 

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about $22. 

about $22 




For the indhidualist 
"Tho happens to be in unifonn 

Lowell Shoe Inc., 95 Bridge Street, Lowell, MA 01852 Dept.CAN4